Nursing Theories and Theorists PDF

Nursing Theories and Theorists rnursingnotes  Nursing theories Nursing theories are organized bodies of knowledge to define what nursing is, what nurses do, and why they do it. Nursing theories provide a way to define nursing as a unique discipline that...

Nursing Theories and Theorists rnursingnotes  Nursing theories Nursing theories are organized bodies of knowledge to define what nursing is, what nurses do, and why they do it. Nursing theories provide a way to define nursing as a unique discipline that is separate from other disciplines (e.g., medicine). It is a framework of concepts and purposes intended to guide nursing practice at a more concrete and specific level. Nursing, as a profession, is committed to recognizing its own unparalleled body of knowledge vital to nursing practice—nursing science. To distinguish this foundation of knowledge, nurses need to identify, develop, and understand concepts and theories in line with nursing. As a science, nursing is based on the theory of what nursing is, what nurses do, and why. Nursing is a unique discipline and is separate from medicine. It has its own body of knowledge on which delivery of care is based. Defining Terms The development of nursing theory demands an understanding of selected terminologies, definitions, and assumptions. Philosophy These are beliefs and values that define a way of thinking and are generally known and understood by a group or discipline. Theory A belief, policy, or procedure proposed or followed as the basis of action. It refers to a logical group of general propositions used as principles of explanation. Theories are also used to describe, predict, or control phenomena. Concept Concepts are often called the building blocks of theories. They are primarily the vehicles of thought that involve images. Models Models are representations of the interaction among and between the concepts showing patterns. They present an overview of the theory’s thinking and may demonstrate how theory can be introduced into practice. Conceptual framework A conceptual framework is a group of related ideas, statements, or concepts. It is often used interchangeably with the conceptual model and with grand theories. Proposition Propositions are statements that describe the relationship between the concepts. Domain The domain is the perspective or territory of a profession or discipline. Process Processes are organized steps, changes, or functions intended to bring about the desired result. Paradigm A paradigm refers to a pattern of shared understanding and assumptions about reality and the world, worldview, or widely accepted value system Metaparadigm A metaparadigm is the most general statement of discipline and functions as a framework in which the more restricted structures of conceptual models develop. Much of the theoretical work in nursing focused on articulating relationships among four major concepts: person, environment, health, and nursing. History of Nursing Theories The first nursing theories appeared in the late 1800s when a strong emphasis was placed on nursing education. In 1860 Florence Nightingale defined nursing in her “Environmental Theory” as “the act of utilizing the patient’s environment to assist him in his recovery.” In the 1950s there is a consensus among nursing scholars that nursing needed to validate itself through the production of its own scientifically tested body of knowledge. In 1952 Hildegard Peplau introduced her Theory of Interpersonal Relations that emphasizes the nurse-client relationship as the foundation of nursing practice. In 1955 Virginia Henderson conceptualized the nurse’s role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs. Thus her Nursing Need Theory was developed. In 1960 Faye Abdellah published her work “Typology of 21 Nursing Problems,” which shifted the focus of nursing from a disease-centered approach to a patient-centered approach.  Ida Jean Orlando emphasized the reciprocal relationship between patient and In 1962 nurse and viewed nursing’s professional function as finding out and meeting the patient’s immediate need for help. Dorothy Johnson pioneered the Behavioral System Model and upheld the In 1968 fostering of efficient and effective behavioral functioning in the patient to prevent illness. Martha Rogers viewed nursing as both a science and an art as it provides a way In 1970 to view the unitary human being, who is integral with the universe. Dorothea Orem stated in her theory that nursing care is required if the client In 1971 is unable to fulfill biological, psychological, developmental, or social needs. Imogene King‘s Theory of Goal attainment stated that the nurse is considered In 1971 part of the patient’s environment and the nurse-patient relationship is for meeting goals towards good health. Betty Neuman, in her theory, states that many needs exist, and each may In 1972 disrupt client balance or stability. Stress reduction is the goal of the system model of nursing practice. In 1979 Sr. Callista Roy viewed the individual as a set of interrelated systems that maintain the balance between these various stimuli. In 1979 Jean Watson developed the philosophy of caring, highlighted humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice.  The Nursing Metaparadigm 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. Person Person (also referred to as Client or Human Beings) is the recipient of nursing care and may include individuals, patients, groups, families, and communities. Environment Environment (or situation) is defined as the 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. Health Health is defined as 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. 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 metaparadigm of different nurse theories PERSON HEALTH NURSE ENVIRONMENT Human beings Nightingale "What nursing has to Nightingale's writings were not defined (1859/1992) did not do... is to put the reflect a community by Nightingale define health patient in the best health model in which NIGHTINGALE specifically specifically condition for nature all that surrounds to act upon him" human beings is (Nightingale, 1859/1992) considered in relation to their state of health. Humans are defined as Health is "being Nursing is an art through The environment has "men, women, and structurally and which the practitioner of physical, chemical children cared for functionally whole nursing gives specialized and biological either singly or as social or sound." assistance to persons with features. It OREM units," and are the disabilities which makes includes the family, "material object" of more than ordinary culture, and nurses and others who assistance necessary to community. provide direct meet needs for self-care. care. Individuals have basic "The unique function of No explicit definition Health was taken to needs that are the nurse is to assist the of the environment, mean balance in all component individual, sick or well, in though she stated realms of of health and require the performance of those that: "maintaining a human life. assistance to achieve activities contributing to supportive HENDERSON health and health or its recovery environment independence that he would perform conducive for health or a peaceful death. unaided if he had the is one of the elements necessary strength, will or of her 14 activities knowledge. And to do this for client assistance." in such a way as to help him gain independence as rapidly as possible." An organism that Health is defined Hildegard Peplau Although Peplau does "strives in its own way as "a word symbol considers nursing not directly address to reduce tension that implies to be a "significant, society/environment, generated by forward movement therapeutic, she does encourage needs." of personality and interpersonal the nurse to consider PEPLAU other ongoing process." the patient's culture human processes in and mores when the the direction of patient adjusts to creative, hospital routine. constructive, productive, personal, and community living."  PERSON HEALTH NURSE ENVIRONMENT A person is defined as an Rogers defines health Nursing aims to assist It is the study of indivisible, pandimensional as an expression of the people in achieving unitary, energy field identified life process their maximum health irreducible, indivisible by a pattern, and potential. human and ROGERS manifesting environmental fields: characteristics specific to people and their the whole, and that can't world. be predicted from knowledge of the parts. Individuals are social Health is a dynamic life Nursing is a process of Environment is the beings who are rational experience of a human action, reaction, and background for and sentient. Humans being, which implies interaction whereby human communicate their continuous adjustment nurse and client share interactions. It is KING thoughts, actions, to stressors in the information about both external to, customs, and beliefs internal and external their perceptions in and internal to, through environment through the nursing the individual. language. optimum use of one's situation. resources to achieve maximum potential for daily living Human being is a Health is the unity and Society provides the Nursing is a human valued person to be harmony within the mind, values that determine science of persons and cared for, body, and soul; health is how one should behave human health-illness WATSON respected, nurtured, associated with the and what goals one experiences that are understood, and degree of congruence should strive mediated by assisted; in general a between the self as toward. professional, philosophical view of perceived and the self as personal, scientific, a person as a fully experienced. esthetic, and ethical functional human care integrated self. transactions. Components of Nursing Theories 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. 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. 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. Abstract Concepts - Defined as mentally constructed independently of a specific time or place. Concrete Concepts - Are directly experienced and related to a particular time or place. Definitions Definitions are used to convey the general meaning of the concepts of the theory. Definitions can be theoretical or operational. Theoretical Definitions - Define a particular concept based on the theorist’s perspective. Operational Definitions - States how concepts are measured. Relational Statements Relational statements define the relationships between two or more concepts. They are the chains that link concepts to one another. Assumptions Assumptions are 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. Why are Nursing Theories Important? Nursing theories are the basis of nursing practice today. In many cases, nursing theory guides knowledge development and directs education, research, and practice. Historically, nursing was not recognized as an academic discipline or as a profession we view today. Before nursing theories were developed, nursing was considered to be a task-oriented occupation. The training and function of nurses were under the direction and control of the medical profession. Let’s take a look at the importance of nursing theory and its significance to nursing practice Nursing theories help recognize what should set the foundation of practice by explicitly describing nursing. By defining nursing, a nursing theory also helps nurses understand their purpose and role in the healthcare setting. Theories serve as a rationale or scientific reasons for nursing interventions and give nurses the knowledge base necessary for acting and responding appropriately in nursing care situations. Nursing theories provide the foundations of nursing practice, generate further knowledge, and indicate which direction nursing should develop in the future (Brown, 1964). By providing nurses a sense of identity, nursing theory can help patients, managers, and other healthcare professionals to acknowledge and understand the unique contribution that nurses make to the healthcare service (Draper, 1990). Nursing theories prepare the nurses to reflect on the assumptions and question the nursing values, thus further defining nursing and increasing the knowledge base. Nursing theories aim to define, predict, and demonstrate nursing phenomenon (Chinn and Jacobs, 1978). It can be regarded as an attempt by the nursing profession to maintain and preserve its professional limits and boundaries. In many cases, nursing theories guide knowledge development and directs education, research, and practice, although each influences the others. (Fitzpatrick and Whall, 2005).  Purposes of Nursing Theories The primary purpose of theory in nursing is to improve practice by positively influencing the health and quality of life of patients. Nursing theories are also developed to define and describe nursing care, guide nursing practice, and provide a basis for clinical decision-making. In the past, the accomplishments of nursing led to the recognition of nursing in an academic discipline, research, and profession. In Academic Discipline Much of the earlier nursing programs identified the major concepts in one or two nursing models, organized the concepts, and build an entire nursing curriculum around the created framework. These models’ unique language was typically introduced into program objectives, course objectives, course descriptions, and clinical performance criteria. The purpose was to explain the fundamental implications of the profession and enhance the profession’s status. In Research The development of theory is fundamental to the research process, where it is necessary to use theory as a framework to provide perspective and guidance to the research study. Theory can also be used to guide the research process by creating and testing phenomena of interest. To improve the nursing profession’s ability to meet societal duties and responsibilities, there needs to be a continuous reciprocal and cyclical connection with theory, practice, and research. This will help connect the perceived “gap” between theory and practice and promote the theory-guided practice. In Profession Clinical practice generates research questions and knowledge for theory. In a clinical setting, its primary contribution has been the facilitation of reflecting, questioning, and thinking about what nurses do. Because nurses and nursing practice are often subordinate to powerful institutional forces and traditions, introducing any framework that encourages nurses to reflect on, question, and think about what they do provide an invaluable service.  Classification of Nursing Theories There are different ways to categorize nursing theories. They are classified depending on their function, levels of abstraction, or goal orientation. By Abstraction There are three major categories when classifying nursing theories based on their level of abstraction: grand theory, middle-range theory, and practice-level theory. Level of nursing theory Grand theories are abstract, broad in scope, and complex, therefore requiring further research for clarification. Grand Nursing Grand nursing theories do not guide specific nursing interventions but Theories rather provide a general framework and nursing ideas. Grand nursing theorists develop their works based on their own experiences and their time, explaining why there is so much variation among theories. Address the nursing metaparadigm components of person, nursing, health, and environment. More limited in scope (compared to grand theories) and present concepts and propositions at a lower level of abstraction. They address a specific Middle-Range phenomenon in nursing. Nursing Theories Due to the difficulty of testing grand theories, nursing scholars proposed using this level of theory. Most middle-range theories are based on a grand theorist’s works, but they can be conceived from research, nursing practice, or the theories of other disciplines. Practice nursing theories are situation-specific theories that are narrow in scope and focuses on a specific patient population at a specific time. Practice-level nursing theories provide frameworks for nursing Practice-Level interventions and suggest outcomes or the effect of nursing practice. Nursing Theories Theories developed at this level have a more direct effect on nursing practice than more abstract theories. These theories are interrelated with concepts from middle-range theories or grand theories By Goal Orientation Theories can also be classified based on their goals. They can be descriptive or prescriptive. Descriptive Theories Descriptive theories are the first level of theory development. They describe the phenomena and identify its properties and components in which it occurs. Descriptive theories are not action-oriented or attempt to produce or change a situation. There are two types of descriptive theories: factor-isolating theory and explanatory theory. Factor-Isolating Theory Explanatory Theory Also known as category-formulating or Explanatory theories describe and explain labeling theory. the nature of relationships of certain Theories under this category describe phenomena to other phenomena. the properties and dimensions of phenomena. Prescriptive Theories Address the nursing interventions for a phenomenon, guide practice change, and predict consequences. Includes propositions that call for change. In nursing, prescriptive theories are used to anticipate the outcomes of nursing interventions.  Other Ways of Classifying Nursing Theories Classification According to Meleis Afaf Ibrahim Meleis (2011), in her book Theoretical Nursing: Development and Progress, organizes the major nurse theories and models using the following headings: needs theories, interaction theories, and outcome theories. These categories indicate the basic philosophical underpinnings of the theories. The needs theorists were the first group of nurses who thought of giving nursing care a conceptual order. Theories under this group are Needs-Based based on helping individuals to fulfill their physical and mental needs. Theories Theories of Orem, Henderson, and Abdella are 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 position. These theories emphasized nursing on the establishment and Interaction maintenance of relationships. They highlighted the impact of nursing on patients and how they interact with the environment, people, and Theories situations. Theories of King, Orlando, and Travelbee are grouped under this category. These theories describe the nurse as controlling and directing patient Outcome care using their knowledge of the human physiological and behavioral Theories systems. The nursing theories of Johnson, Levine, Rogers, and Roy belong to this group.  Classification According to Alligood In her book, Nursing Theorists and Their Work, Raile Alligood (2017) categorized nursing theories into four headings: nursing philosophy, nursing conceptual models, nursing theories and grand theories, and middle-range nursing theories. It is the most abstract type and sets forth the meaning of nursing phenomena through analysis, Nursing Philosophy reasoning, and logical presentation. Works of Nightingale, Watson, Ray, and Benner are categorized under this group. These are comprehensive nursing theories that are regarded by some as pioneers in nursing. These theories address the nursing metaparadigm and explain Nursing the relationship between them. Conceptual models of Conceptual Models Levine, Rogers, Roy, King, and Orem are under this group. Are works derived from nursing philosophies, conceptual Grand Nursing models, and other grand theories that are generally not as specific as middle-range theories. Works of Levine, Theories Rogers, Orem, and King are some of the theories under this category. Are precise and answer specific nursing practice Middle-Range questions. They address the specifics of nursing situations Theories within the model’s perspective or theory from which they are derived. Examples of Middle-Range theories are that of Mercer, Reed, Mishel, and Barker.  List of Nursing Theories and Theorists Florence Nightingale Environmental Theory Founder of Modern Nursing and Pioneer Defined Nursing as “the act of utilizing the environment of the patient to assist him in his recovery.” Stated that nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient.” Identified five (5) environmental factors: fresh air, pure water, efficient drainage, cleanliness or sanitation, and light or direct sunlight. Hildegard E. Peplau Interpersonal Relations Theory Peplau’s theory defined Nursing as “An interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse specially educated to recognize, respond to the need for help.” Her work is influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller. It helps nurses and healthcare providers develop more therapeutic interventions in the clinical setting.  Virginia Henderson Nursing Need Theory Focuses on the importance of increasing the patient’s independence to hasten their progress in the hospital. Emphasizes the basic human needs and how nurses can assist in meeting those needs. “The nurse is expected to carry out a physician’s therapeutic plan, but individualized care is the result of the nurse’s creativity in planning for care.” Faye Glenn Abdellah 21 Nursing Problems Theory “Nursing is based on an art and science that molds 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.” Changed the focus of nursing from disease-centered to patient- centered and began to include families and the elderly in nursing care. The nursing model is intended to guide care in hospital institutions but can also be applied to community health nursing, as well. Ernestine Wiedenbach The Helping Art of Clinical Nursing conceptual model Definition of nursing reflects on nurse-midwife experience as “People may differ in their concept of nursing, but few would disagree that nursing is nurturing or caring for someone in a motherly fashion.” Guides the nurse action in the art of nursing and specified four elements of clinical nursing: philosophy, purpose, practice, and art. Clinical nursing is focused on meeting the patient’s perceived need for help in a vision of nursing that indicates considerable importance on the art of nursing.  Lydia E. Hall Care, Cure, Core Nursing Theory Hall defined Nursing as the “participation in care, core and cure aspects of patient care, where CARE is the sole function of nurses, whereas the CORE and CURE are shared with other members of the health team.” The major purpose of care is to achieve an interpersonal relationship with the individual to facilitate the development of the core. The “care” circle defines a professional nurse’s primary role, such as providing bodily care for the patient. The “core” is the patient receiving nursing care. The “cure” is the aspect of nursing that involves the administration of medications and treatments. Joyce Travelbee Human-to-Human Relationship Model States in her Human-to-Human Relationship Model that the purpose of nursing was to help and support an individual, family, or community to prevent or cope with the struggles of illness and suffering and, if necessary, to find significance in these occurrences, with the ultimate goal being the presence of hope. Nursing was accomplished through human-to-human relationships. Extended the interpersonal relationship theories of Peplau and Orlando. Evelyn Adam Focuses on the development of models and theories on the concept of nursing. Includes the profession’s goal, the beneficiary of the professional service, the role of the professional, the source of the beneficiary’s difficulty, the intervention of the professional, and the consequences. A good example of using a unique basis of nursing for further expansion.  Kathryn E. Barnard Child Health Assessment Model Concerns improving the health of infants and their families. Her findings on parent-child interaction as an important predictor of cognitive development helped shape public policy. She is the founder of the Nursing Child Assessment Satellite Training Project (NCAST), which produces and develops research-based products, assessment, and training programs to teach professionals, parents, and other caregivers the skills to provide nurturing environments for young children. Borrows from psychology and human development and focuses on mother-infant interaction with the environment. Contributed a close link to practice that has modified the way health care providers assess children in light of the parent- child relationship. Nancy Roper, Winifred Logan, and Alison J. Tierney A Model for Nursing Based on a Model of Living Logan produced a simple theory, “which actually helped bedside nurses.” The trio collaborated in the fourth edition of The Elements of Nursing: A Model for Nursing Based on a Model of Living and prepared a monograph entitled The Roper-Logan-Tierney Model of Nursing: Based on Activities of Daily Living. Includes maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temperature, mobilizing, working and playing, expressing sexuality, sleeping, and dying. Jean Watson She pioneered the Philosophy and Theory of Transpersonal Caring. “Nursing is concerned with promoting health, preventing illness, caring for the sick, and restoring health.” Mainly concerns with how nurses care for their patients and how that caring progresses into better plans to promote health and wellness, prevent illness and restore health. Focuses on health promotion, as well as the treatment of diseases. Caring is central to nursing practice and promotes health better than a simple medical cure.  Ida Jean Orlando She developed the Nursing Process Theory. “Patients have their own meanings and interpretations of situations, and therefore nurses must validate their inferences and analyses with patients before drawing conclusions.” Allows nurses to formulate an effective nursing care plan that can also be easily adapted when and if any complexity comes up with the patient. According to her, persons become patients requiring nursing care when they have needs for help that cannot be met independently because of their physical limitations, negative reactions to an environment, or experience that prevents them from communicating their needs. The role of the nurse is to find out and meet the patient’s immediate needs for help. Marilyn Anne Ray Developed the Theory of Bureaucratic Caring “Improved patient safety, infection control, reduction in medication errors, and overall quality of care in complex bureaucratic health care systems cannot occur without knowledge and understanding of complex organizations, such as the political and economic systems, and spiritual-ethical caring, compassion and right action for all patients and professionals.” Challenges participants in nursing to think beyond their usual frame of reference and envision the world holistically while considering the universe as a hologram. Presents a different view of how health care organizations and nursing phenomena interrelate as wholes and parts in the system  Patricia Benner Caring, Clinical Wisdom, and Ethics in Nursing Practice “The nurse-patient relationship is not a uniform, professionalized blueprint but rather a kaleidoscope of intimacy and distance in some of the most dramatic, poignant, and mundane moments of life.” Attempts to assert and reestablish nurses’ caring practices when nurses are rewarded more for efficiency, technical skills, and measurable outcomes. States that caring practices are instilled with knowledge and skill regarding everyday human needs. Kari Martinsen Philosophy of Caring “Nursing is founded on caring for life, on neighborly love, […]At the same time, the nurse must be professionally educated.” Human beings are created and are beings for whom we may have administrative responsibility. Caring, solidarity, and moral practice are unavoidable realities. Katie Eriksson Theory of Carative Caring “Caritative nursing means that we take ‘caritas’ into use when caring for the human being in health and suffering. Caritative caring is a manifestation of the love that ‘just exists’. Caring communion, true caring, occurs when the one caring in a spirit of caritas alleviates the suffering of the patient.” The ultimate goal of caring is to lighten suffering and serve life and health. Inspired many in the Nordic countries and used it as the basis of research, education, and clinical practice.  Myra Estrin Levine According to the Conservation Model, “Nursing is human interaction.” Provides a framework within which to teach beginning nursing students. Logically congruent, externally and internally consistent, has breadth and depth, and is understood, with few exceptions, by professionals and consumers of health care. Martha E. Rogers In Roger’s Theory of Human Beings, she defined Nursing as “an art and science that is humanistic and humanitarian. The Science of Unitary Human Beings contains two dimensions: the science of nursing, which is the knowledge specific to the field of nursing that comes from scientific research; and the art of nursing, which involves using nursing creatively to help better the lives of the patient. A patient can’t be separated from his or her environment when addressing health and treatment. Dorothea E. Orem In her Self-Care Theory, she defined Nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at the home level of effectiveness.” Focuses on each individual’s ability to perform self-care. Composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory, and supportive-educative.  Imogene M. King Conceptual System and Middle-Range Theory of Goal Attainment “Nursing is a process of action, reaction and interaction by which nurse and client share information about their perception in a nursing situation” and “a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore 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 their patients to meet good health goals. Explains that the nurse and patient go hand-in-hand in communicating information, set goals together, and then take actions to achieve those goals. Betty Neuman In Neuman’s System Model, she defined nursing as a “unique profession in that is concerned with all of the variables affecting an individual’s response to stress.” The focus is on the client as a system (which may be an individual, family, group, or community) and on the client’s responses to stressors. The client system includes five variables (physiological, psychological, sociocultural, developmental, and spiritual). It is conceptualized as an inner core (basic energy resources) surrounded by concentric circles that include lines of resistance, a normal defense line, and a flexible line of defense. Sister Callista Roy In Adaptation Model, Roy defined nursing as a “health care profession that focuses on human life processes and patterns and emphasizes the promotion of health for individuals, families, groups, and society as a whole.” Views the individual as a set of interrelated systems that strives to maintain a balance between various stimuli. Inspired the development of many middle-range nursing theories and adaptation instruments  Dorothy E. Johnson The Behavioral System Model defined Nursing as “an external regulatory force that acts to preserve the organization and integrate the patients’ behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical or social health or in which illness is found.” Advocates to foster efficient and effective behavioral functioning in the patient to prevent illness and stresses the importance of research-based knowledge about the effect of nursing care on patients. Describes the person as a behavioral system with seven subsystems: the achievement, attachment-affiliative, aggressive-protective, dependency, ingestive, eliminative, and sexual subsystems. Anne Boykin and Savina O. Schoenhofer The Theory of Nursing as Caring: A Model for Transforming Practice Nursing is an “exquisitely interwoven” unity of aspects of the discipline and profession of nursing. Nursing’s focus and aim as a discipline of knowledge and a professional service are “nurturing persons living to care and growing in caring.” Caring in nursing is “an altruistic, active expression of love, and is the intentional and embodied recognition of value and connectedness.” Afaf Ibrahim Meleis Transitions Theory It began with observations of experiences faced as people deal with changes related to health, well-being, and the ability to care for themselves. Types of transitions include developmental, health and illness, situational, and organizational. Acknowledges the role of nurses as they help people go through health/illness and life transitions. Focuses on assisting nurses in facilitating patients’, families’, and communities’ healthy transitions.  Nola J. Pender Health Promotion Model Describes the interaction between the nurse and the consumer while considering the role of the health promotion environment. It focuses on three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes. Describes the multidimensional nature of persons as they interact within their environment to pursue health. Madeleine M. Leininger Involves learning and understanding various cultures regarding nursing and health-illness caring practices, beliefs, and values to implement significant and efficient nursing care services to people according to their cultural values and health-illness context. It focuses on the fact that various cultures have different and unique caring behaviors and different health and illness values, beliefs, and patterns of behaviors. Culture Care Theory of Diversity and Universality Defined transcultural nursing as “a substantive area of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different cultures to provide culture-specific and universal nursing care practices in promoting health or well-being or to help people to face unfavorable human conditions, illness, or death in culturally meaningful ways.” Modeling and Role-Modeling Helen C. Erickson, “Nursing is the holistic helping of persons with their self-care activities in relation to their health. The goal is to achieve a state Evelyn M. Tomlin, of perceived optimum health and contentment.” and Mary Ann P. Modeling is a process that allows nurses to understand the unique perspective of a client and learn to appreciate its importance. Swain Role-modeling occurs when the nurse plans and implements interventions that are unique for the client.  Rosemarie Rizzo Parse Human Becoming Theory “Nursing is a science, and the performing art of nursing is practiced in relationships with persons (individuals, groups, and communities) in their processes of becoming.” Explains that a person is more than the sum of the parts, the environment, and the person is inseparable 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. Gladys L. Husted and James H. Husted Created the Symphonological Bioethical Theory “Symphonology (from ‘symphonia,’ a Greek word meaning agreement) is a system of ethics based on the terms and preconditions of an agreement.” Nursing cannot occur without both nurse and patient. “A nurse takes no actions that are not interactions.” Founded on the singular concept of human rights, the essential agreement of non-aggression among rational people forms the foundation of all human interaction. 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 nursing 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 time. The mother becomes attached to her infant, acquires competence in the caretaking tasks involved in the role, and expresses pleasure and gratification. (Mercer, 1986). Provides proper health care interventions for nontraditional mothers for them to favorably adopt a strong maternal identity.  Merle H. Mishel Uncertainty in Illness Theory Presents a comprehensive structure to view the experience of acute and chronic illness and organize nursing interventions to promote optimal adjustment. Describes how individuals form meaning from illness-related situations. The original theory’s concepts were organized in a linear model around the following three major themes: Antecedents of uncertainty, Process of uncertainty appraisal, and Coping with uncertainty. Pamela G. Reed Self-Transcendence Theory Self-transcendence refers to the fluctuation of perceived boundaries that extend the person (or self) beyond the immediate and constricted views of self and the world (Reed, 1997). Has three basic concepts: vulnerability, self-transcendence, and well-being. Gives insight into the developmental nature of humans associated with health circumstances connected to nursing care. Carolyn L. Wiener and Marylin J. Dodd Theory of Illness Trajectory “The uncertainty surrounding a chronic illness like cancer is the uncertainty of life writ large. By listening to those who are tolerating this exaggerated uncertainty, we can learn much about the trajectory of living.” Provides a framework for nurses to understand how cancer patients stand uncertainty manifested as a loss of control. Provides new knowledge on how patients and families endure uncertainty and work strategically to reduce uncertainty through a dynamic flow of illness events, treatment situations, and varied players involved in care organization. Georgene Gaskill Eakes, Mary Lermann Burke, and Margaret A. Hainsworth Theory of Chronic Sorrow “Chronic sorrow is the presence of pervasive grief-related feelings that have been found to occur periodically throughout the lives of individuals with chronic health conditions, their family caregivers and the bereaved.” This middle-range theory defines the aspect of chronic sorrow as a normal response to the ongoing disparity created by the loss. Cornelia M. Ruland and Shirley M. Moore Peaceful End-of-Life Theory The focus was not on death itself but on providing a peaceful and meaningful living in the time that remained for patients and their significant others. The purpose was to reflect the complexity involved in caring for terminally ill patients. Phil Barker Barker’s Tidal Model of Mental Health Recovery is widely used in mental health nursing. It focuses on nursing’s fundamental care processes, is universally applicable, and is a practical guide for psychiatry and mental health nursing. Draws on values about relating to people and help others in their moments of distress. The values of the Tidal Model are revealed in the Ten Commitments: Value the voice, Respect the language, Develop genuine curiosity, Become the apprentice, Use the available toolkit, Craft the step beyond, Give the gift of time, Reveal personal wisdom, Know that change is constant, and Be transparent. Katharine Kolcaba Theory of Comfort “Comfort is an antidote to the stressors inherent in health care situations today, and when comfort is enhanced, patients and families are strengthened for the tasks ahead. Also, nurses feel more satisfied with the care they are giving.” Patient comfort exists in three forms: relief, ease, and transcendence. These comforts can occur in four contexts: physical, psychospiritual, environmental, and sociocultural. As a patient’s comfort needs change, the nurse’s interventions change, as well. Cheryl Tatano Beck Postpartum Depression Theory “The birth of a baby is an occasion for joy—or so the saying goes. But for some women, joy is not an option.” Described nursing as a caring profession with caring obligations to persons we care for, students, and each other. Provides evidence to understand and prevent postpartum depression. Kristen M. Swanson Theory of Caring “Caring is a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility.” Defines nursing as informed caring for the well-being of others. Offers a structure for improving up-to-date nursing practice, education, and research while bringing the discipline to its traditional values and caring-healing roots.  Terms and conditions: By purchasing, you agree with the following terms and conditions: 1. You agree that this study guides are simply guides and should not be used over and above your course material and teacher instruction in nursing school 2. These study guides are not intended to be used as medical advice or clinical practice, they are for education use only 3. You also agree NOT to distribute or share the materials under any circumstances References: Alligood, M., & Tomey, A. (2010). Nursing theorists and their work, seventh edition (No ed.). Maryland Heights: Mosby-Elsevier. Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences. Barnard, K. E. (1984). Nursing research related to infants and young children. In Annual review of nursing research (pp. 3-25). Springer, Berlin, Heidelberg. Brown, H. I. (1979). Perception, theory, and commitment: The new philosophy of science. University of Chicago Press. [Link] Brown M (1964) Research in the development of nursing theory: the importance of a theoretical framework in nursing research. Nursing Research. Chinn, P. L., & Jacobs, M. K. (1978). A model for theory development in nursing. Advances in Nursing Science, 1(1), 1-12. [Link] Colley, S. (2003). Nursing theory: its importance to practice. Nursing Standard (through 2013), 17(46), 33. [Link] Fawcett, J. (2005). Criteria for evaluation of theory. Nursing science quarterly, 18(2), 131-135. [Link] Fitzpatrick, J. J., & Whall, A. L. (Eds.). (1996). Conceptual models of nursing: Analysis and application. Connecticut, Norwalk: Appleton & Lange. Kaplan, A. (2017). The conduct of inquiry: Methodology for behavioural science. Routledge. [Link] Meleis, A. I. (2011). Theoretical nursing: Development and progress. Lippincott Williams & Wilkins. Neuman, B. M., & Fawcett, J. (2002). The Neuman systems model. Nightingale F (1860) Notes on Nursing. New York NY, Appleton. Peplau H (1988) The art and science of nursing: similarities, differences, and relations. Nursing Science Quarterly Rogers M (1970) An Introduction to the Theoretical Basis of Nursing. Philadelphia PA, FA Davis. The Core is protected by: LINES OF RESISTANCE (LR) - represents the internal factors that help the patient defend against a stressor - example: body’s immune response system RECONSTITUTION The return and maintenance of system stability, following treatment of stressor which may result in a higher or lower level of wellness. The purpose of the nurse is to retain the system’s stability through PREVENTION.  Patient–Centered Approaches to Nursing  To promote good hygiene To promote optimal activity, and physical comfort exercise, rest, and sleep To maintain good body mechanics and prevent and correct deformities To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection The nursing-centered orientation to client care seems contrary to the client-centered approach that Abdellah professes to uphold. The apparent contradiction can be explained by her desire to move away from a disease-centered orientation. In her attempt to bring nursing practice to its proper relationship with restorative and preventive measures for meeting total client needs, she seems to swing the pendulum to the opposite pole, from the disease orientation to nursing orientation, while leaving the client somewhere in the middle.  Conclusion  Abdellah ‘s typology of 21 nursing problems is a conceptual model mainly concerned with patient’s needs and the role of nurses in problem identification using a problem analysis approach.  Patient-centered approaches to nursing health are described as a state mutually exclusive of illness. Abdellah does not provide a definition of health but speaks to “total health needs” and “a healthy state of mind and body” in her description of nursing.  However, Abdellah rather conceptualized nurses’ actions in nursing care which is contrary to her aim of formulating a clear categorization of patient’s problems as health needs. Nurses roles were defined to alleviate the problems assessed through the proposed problem-solving approach. As a whole, the theory is intended to guide care not just in the hospital setting, but can also be applied to community nursing, as well. The model has interrelated concepts of health and nursing problems, as well as problem- solving, which is an activity inherently logical in nature.  In 1939, she was the author of three editions of “Principles and Practices of Nursing,” a widely used text. Her “Basic Principles of Nursing Care,” published in 1960 and with the most current revision in 1997, it has been published in 27 languages by the International Council of Nurses.  Henderson co-authored the fifth (1955) and sixth (1978) editions of ”Textbook of Principles and Practice of Nursing” when the original author, Bertha Harmer, died. Until 1975, the book’s fifth edition was the most widely adopted nursing textbook in English and Spanish by various nursing schools.  Lydia Eloise Hall (1906-1969) Care, Core and Cure Nursing Theory Theory also referred as “The Three Interlocking Circles Theory” Rationale: Related a portion of Hall’s theory to everyday clinical practice. Hall’s dedication is to achieve interpersonal relationship with the patient and then facilitate healing. Involvement of the patient in decisions regarding health care, utilizing self-efficacy, is still currently utilized frequently. Hildegard Peplau Interpersonal Relations Theory In 1952, Hildegard Peplau published her Theory of Interpersonal Relations that was influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller Interpersonal Relations Theory Hildegard Peplau’s Interpersonal Relations Theory emphasized the nurse-client relationship as the foundation of nursing practice. -It gave emphasis on the give-and-take of nurse-client relationships that was seen by many as revolutionary. Peplau went on to form an interpersonal model emphasizing the need for a partnership between nurse and client as opposed to the client passively receiving treatment and the nurse passively acting out doctor’s orders.  Description Hildegard E. Peplau’s theory defined Nursing as “An interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.” It is a “maturing force and an educative instrument” involving an interaction between two or more individuals with a common goal.  In nursing, this common goal provides the incentive for the therapeutic process in which the nurse and patient respect each other as individuals, both of them learning and growing as a result of the interaction. An individual learns when she or he selects stimuli in the environment and then reacts to these stimuli.  Assumptions The assumptions of Hildegard Peplau’s Interpersonal Relations Theory are: (1) Nurse and the patient can interact. (2) Peplau emphasized that both the patient and nurse mature as the result of the therapeutic interaction. (3) Communication and interviewing skills remain fundamental nursing tools. (4) Peplau believed that nurses must clearly understand themselves to promote their client’s growth and to avoid limiting the client’s choices to those that nurses value.  Major Concepts of the Interpersonal Relations Theory The theory explains the purpose of nursing is to help others identify their felt difficulties and that nurses should apply principles of human relations to the problems that arise at all levels of experience. Major Concepts of the Interpersonal Relations Theory A. Man Peplau defines man as an organism that “strives in its own way to reduce tension generated by needs.” The client is an individual with a felt need Major Concepts of the Interpersonal Relations Theory B. Health Health is defined as “a word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living.” Major Concepts of the Interpersonal Relations Theory C. Society or Environment Although Peplau does not directly address society/environment, she does encourage the nurse to consider the patient’s culture and mores when the patient adjusts to hospital routine.  Major Concepts of the Interpersonal Relations Theory D. Nursing Hildegard Peplau considers nursing to be a “significant, therapeutic, interpersonal process.” She defines it as a “human relationship between an individual who is sick, or in need of health services, and a nurse specially educated to recognize and to respond to the need for help.” Peplau's Six Nursing Roles: 1.Stranger Role 2. Resources Role 3. Teaching Role 4. Counseling Role 5. Surrogate Role 6. Leadership Role  Resources Role The nurse provides answers to questions primarily on health information. The resource person is also in charge of relaying information to the patient about the treatment plan. Usually the questions arise from larger problems, therefore the nurse would determine what type of response is appropriate for constructive learning. The nurse should provide straightforward answers when providing information on counseling.  Teaching Role The teaching role is a role that is a combination of all roles. Peplau determined that there are two categories that the teaching role consists of: Instructional and experimental. The instructional consists of giving a wide variety of information that is given to the patients and experimental is using the experience of the learner as a starting point to later form products of learning which the patient makes about their experiences.  Counseling Role Peplau believes that counselling has the biggest emphasis in psychiatric nursing. The counselor role helps the patient understand and remember what is going on and what is happening to them in current life situations. Also, to provide guidance and encouragement to make changes.  Surrogate Role The patient is responsible for putting the nurse in the surrogate role. The nurse's behaviors and attitudes create a feeling tone for the patient that trigger feelings that were generated in a previous relationship. The nurse helps the patient recognize the similarities and differences between the nurse and the past relationship.  Leadership Role Helps the patient assume maximum responsibility for meeting treatment goals in a mutually satisfying way. The nurse helps the patient meet these goals through cooperation and active participation with the nurse. CULTURAL CARE THEORY MADELEINE M. LEININGER THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER ▸ Was born in Sutton, Nebraska on July 13, 1925, lived on a farm with four brothers and sisters, and graduated from Sutton High School. ▸ Her desire to pursue a career in nursing was due to her inspiration and experience with her aunt who suffered from congenital heart disease. THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER ▸ Nationally and Internationally known Educator, Author, Theorist, Administrator, Researcher, Consultant, and Public Speaker. ▸ A distinguished visiting professor and scholar at approximately 70 universities in the U.S, Canada, and overseas. THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER - CULTURAL CARE THEORY ▸The cultural care theory aims to provide culturally congruent nursing care through “cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are mostly tailor-made to fit with individual’s, group’s, or institution’s cultural values, beliefs, and lifeways” (Leininger, M. M. (1995). THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER - CULTURAL CARE THEORY ▸The theory’s culturalogical assessment provides a holistic, comprehensive overview of the client’s background. The assessment addresses the following: Communication and Language Gender Considerations Sexual Orientation Ability and Disability Occupation THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER - CULTURAL CARE THEORY Age Socioeconomic Status Interpersonal Relationships Appearance Dress Use of Space Foods and Meal Preparation and Related life ways CULTURE CARE DIVERSITY AND UNIVERSALITY THEORY ▸ Dr. Leininger, focuses on describing, explaining and predicting nursing similarities and differences focused primarily on human care and caring in human cultures. ▸ Nursing is a learned profession with a disciplined focus on care phenomena. ▸ The Culture Care Diversity & Universality theory does not focus on medical symptoms, disease entities or treatments. ▸CULTURE CARE DIVERSITY refers to the differences in meanings, values, or acceptable forms of care in or between groups of people. ▸CULTURE CARE UNIVERSALITY refers to common care or similar meanings that are evident among many cultures. ▸The main focus of Leininger's theory is for the nursing care to fit with or have beneficial meaning and health outcomes for people of different or similar cultural backgrounds. THE SUNRISE MODEL ▸The Leininger Sunrise Model represents the structure of culture care theory by describing the relationship between anthropological and nursing beliefs and principles. THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER - CULTURAL CARE THEORY ▸Leininger proposes that there are three modes for guiding nurses judgements, decisions, or actions in order to provide appropriate, beneficial, and meaningful care: preservation and/or maintenance; accommodation and/or negotiation; and re- patterning and/or restructuring. The modes have greatly influenced the nurse’s ability to provide culturally congruent nursing care, as well as fostering culturally-competent nurses. THREE MODES OF NURSING CARE DECISIONS AND ACTIONS CULTURAL CARE PRESERVATION OR MAINTENANCE cultural care preservation is also known as maintenance and includes those assistive, supporting, facilitative, or enabling professional actions and decisions that help people of a particular culture to retain and/or preserve relevant care values so that they can maintain their well-being, recover from illness, or face handicaps and/or death.  CULTURAL CARE ACCOMMODATION OR NEGOTIATION ▸ Cultural care accommodation also known as negotiation, includes those assistive, supportive, facilitative, or enabling creative professional actions and decisions that help people of a designated culture to adapt to or negotiate with others for a beneficial or satisfying health outcome with professional care providers.  ▸CULTURE CARE REPATTERNING OR RESTRUCTURING ▸Culture care repatterning or restructuring includes those assistive, supporting, facilitative, or enabling professional actions and decisions that help a clients reorder, change, or greatly modify their life ways for new, different, and beneficial health care pattern while respecting the clients cultural values and beliefs and still providing a beneficial or healthier lifeway than before the changes were co-established with the clients. (Leininger, 1991) THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER - CULTURAL CARE THEORY ▸ Leininger’s model makes the following assumptions: Care is the essence of nursing and a distinct, dominant, and unifying focus. Caring is essential for well-being, health, growth, and to face death. culture care is the broadest holistic means by which a nurse can know, explain, interpret, and predict nursing care phenomena to guide nursing care practices. THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER - CULTURAL CARE THEORY Nursing is a transcultural, humanistic, and scientific care discipline and profession with the central purpose to serve human beings worldwide. Caring is essential to curing and healing. There can be no curing without caring. Culture care concepts, meanings, expressions, processes, and structural forms of care are different and similar among all cultures of the world. Every human culture has lay care knowledge and practices and usually some professional care knowledge and practices which vary transculturally. THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER - CULTURAL CARE THEORY Culture care values, beliefs, and practices are influenced in the context of a particular culture. They tend to be embedded in such things as worldview, language, spirituality, kinship, politics and economics, education, technology, and environment. Beneficial, healthy, and satisfying culturally- based nursing care contributes to the well- being of individuals, families, and communities within their environmental context. THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER - CULTURAL CARE THEORY Culturally congruent nursing care can only happen when the patient, family, or community values, expressions, or patterns are known and used appropriately, and in meaningful ways by the nurse with people. Culture care differences and similarities between the nurse and patient exist in any human culture worldwide. Clients who experience nursing care that fails to be reasonably congruent with their beliefs, values, and caring life ways will show signs of cultural conflicts, noncompliance, stresses and ethical or moral concerns. THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER - CULTURAL CARE THEORY Clients who experience nursing care that fails to be reasonably congruent with their beliefs, values, and caring life ways will show signs of cultural conflicts, noncompliance, stresses and ethical or moral concerns. The qualitative paradigm provides new ways of knowing and different ways to discover the epistemic and ontological dimensions of human care. THEORETICAL FRAMEWORKS IN NURSING MADELEINE M. LEININGER - CULTURAL CARE THEORY ▸The Cultural Care Theory defines nursing as a learned scientific and humanistic profession that focuses on human care phenomena and caring activities in order to help, support, facilitate or enable patients to maintain or regain health in culturally meaningful ways, or help them face handicaps or death.  CONCLUSION ▸The purpose of the culture care theory has been to discover culture care with the goal of using the knowledge to combine and professional care. ▸The goal is to provide cultural congruent nursing care using the three modes of nursing actions and decision making THANK YOU!