Nursing Theories PDF

NURA 1311: Theory, Ethics & Professionalism in Nursing Nursing Theories Asst. Prof. Dr. Siti Noorkhairina Sowtali Department of Professional Nursing Studies Kulliyyah of Nursing  ACKNOWLEDGEMENT Asst. Prof. Dr. Norfadzilah Ahmad (RN, PhD) D...

NURA 1311: Theory, Ethics & Professionalism in Nursing Nursing Theories Asst. Prof. Dr. Siti Noorkhairina Sowtali Department of Professional Nursing Studies Kulliyyah of Nursing  ACKNOWLEDGEMENT Asst. Prof. Dr. Norfadzilah Ahmad (RN, PhD) Department of Professional Nursing Studies Kulliyyah of Nursing & Asst. Prof. Dr. Khin Thandar Aung Department of Critical Care Nursing Kulliyyah of Nursing  Learning outcomes At the end of the learning session, the students will be able to:- 1.Understand Nursing profession & its foundation 2.Define theory according to nursing philosophy 3.State the difference between theory & model 4.State the components of a theory 5.List different types of theory 6.Explain different types of theory in nursing 7.Discuss different types of theory in Nursing and its application in nursing practice including:- a) Nightingale’s Theory (Environment) b) Virginia Henderson (Activity of Daily Livings) c) Orem’s Theory (Self-care) d) Leininger’s Theory (Transcultural) e) Watson’s Theory (Caring) f) Roy’s Theory (Adaptation) g) Peplau’s Theory (Interpersonal relation)  LET’S PLAY THIS GAME Find the following words in 2 minutes time. Go to this link: https://thewordsearch.com/puzzle/6862821/ nursing-theories-theorist/ YOUR TIME START NOW! TIMER 10 20 40 50 60 30 TIMER 10 20 40 50 60 30 YOUR TIME END……  WHAT IS NURSING? Nursing is the “…diagnosis & treatment of human responses to actual or potential health problems…” (American Nurses Association, 2010) A nurse DOES NOT medically diagnosed a patient’s health condition as heart failure. However, a nurse will ASSESS a patient’s response to the decrease in activity tolerance as a result of the disease and DEVELOP NURSING DIAGNOSES of fatigue, activity intolerance & ineffective coping. Then the nurse will create a PATIENT CENTERED PLAN OF CARE based on the above diagnoses/health problems. Therefore, nurses need to apply critical thinking skills to integrate KAP & experience according to the standards into the individualized plan of care. (Potter & Perry, 2013) NURSING PROFESSION: ARE WE PROFESSIONAL? CONCEPTS COMMON TO NURSING MODELS Four key concepts common to all 1. Person/Patient (client) A small group or a large collective of individuals (community) Complex entities affected by factors as mind, body and environment need not have an illness Needs are different according to each person. CONCEPTS COMMON TO NURSING MODELS (Cont.) 2. Health Not an absence of disease, but seen as a continuum (moving depending on circumstances and health status) Perception of health varies radically depending on age & culture Health includes: i. Cultural perception ii. Historical perception iii. Continuum of range of health states Role of nurses: To provide the best care  CONCEPTS COMMON TO NURSING MODELS (Cont.) 3. Environment Includes ‘simple’ physical environment to ‘larger picture’ (public sanitation, air & water quality) also, interpersonal & social interactions also, ‘internal environment’ e.g. An adolescence girl with young hypertension need to adapt her treatment plan with her schooling, physical activities & peer relationship.  CONCEPTS COMMON TO NURSING MODELS (Cont.) 4. Nursing Delineates the function and role that nurses have in their relationship with clients Historically, nursing provided all basic care, psychological support and relief of discomfort. Now, the challenge has expand in healthcare industry. e.g. Nurses are expected to perform evidence based practice in their nursing care; to have specialization; working in multidisciplinary team & etc.  Theory-Based Education PhD: a research degree that generates new, discipline- specific knowledge. Master’s: use theoretical perspectives focused on the patient for specific nursing outcomes; base practice on evidence from research & experience. BSN: introduced to research process & the use of theory to guide it. ADN: find middle range theories useful as they are specific to patient care.  Theory-Based Practice Occurs when nurses intentionally structure their practice around a particular nursing theory and use it to guide them in their care of the patient. Provides a systematic way of thinking about nursing that is consistent and guides the decision-making process. Challenges conventional views of patients, illness, the health care delivery system, and traditional nursing interventions.  Theory-Based Research Great strides have been made in the last 25 years in nursing research Nursing research tests and refines the knowledge base of nursing Research findings enable nurses to improve the quality of care and understand how evidence-based nursing influences patient outcomes Research is vital to the future of nursing and theory is integral to research  Benefits Explain practice to others Passes on knowledge to students Contributes to professional autonomy Develops analytical skills, challenges thinking, and clarifies your values and assumptions  DEFINITION Theory is defined as: – “a belief, policy, or procedure proposed or followed as the basis of action”. – “a way of seeing through a set of relatively concrete & specific concepts & the propositions that describe or link the concepts.” Nursing theory is: – “an organized framework of concepts and purposes designed to guide the practice of nursing”. – “A conceptualization of some aspect of nursing that describes, explains, predicts or prescribed nursing care.” (Potter & Perry, 2013)  Why is Theory Important? Nursing is strengthened when knowledge is built on sound theory Criteria to be a profession: distinct body of knowledge as the basis for practice Nursing must be viewed as a scholarly academic discipline that contributes to society The ultimate goal is to support excellence in practice (e.g. evidence based practice-EBP) By using theories, nurses will be better able to use theoretical info in their practice to provide new ways of approaching nursing care and improving practice! NURSING PROFESSION: ARE WE PROFESSIONAL? Yes, we are! When we are practicing aligned with theory, we are actually linking the scientific inquiry during decision making, problem solving & nursing interventions. THEORY VS MODEL  DIFFERENCES BETWEEN THEORY & MODEL THEORY MODEL Definition A speculative statement Hypothetical representation of involving some element of something that exists in reality reality that has not been proven Purpose Describe & explain a Attempt to explain a complex particular nursing action in reality in a systematic and order to make a hypothesis organized manner (or predict its outcome) Concept Theory explains more Model may be with pictures or words Example Systems Theory by Betty Health Belief Model Neuman (2011) Components of a nursing theory https://nursekey.com/theoretical-foundations-of-nursing-practice/  Types of Theory Theories have different purposes and classified by level of abstraction or the goals of the theory as follows:- 1. Grand theories: Systematic and broad in scope, complex & therefore require further specification through research. E.g. Neuman’s system model 2. Middle range theories: Limited in scope and more abstract that address specific phenomena & reflect practice in administration, clinical or teaching. E.g. Issues on incontinence or uncertainty by Mishel’s (1990) 3. Descriptive theories: The first level of theory development which do not direct specific nursing activities but help to explain nursing assessment. 4. Prescriptive theories: Addresses nursing interventions for a phenomenon, describe the conditions under which the prescription occurs & predict the consequences. E.g. Effective decision-making: applying the theories to nursing practice by Watkins (2020).  SELECTED NURSING THEORIES Nightingale’s Theory (Environment) Virginia Henderson (Activity of Daily Livings) Orem’s Theory (Self-care) Leininger’s Theory (Transcultural) Watson’s Theory (Caring) Roy’s Theory (Adaptation) Peplau’s Theory (Interpersonal relation) A Brief History of Nursing Theories The first nursing theories appeared in the late 1800s when a strong emphasis was placed on nursing education. One of the first nursing theorists was Florence Nightingale, who published her thoughts on nursing during the Crimean War in 1859. Nurses role not only focus administer treatments & medication. Focus on providing fresh air, light, warmth, cleanliness, quiet & adequate nutrition. She has shaped the vision for nursing profession in practice, research & education Florence Nightingale Born on May 12, 1820 in Florence, Italy and since 1821 brought up in England Well-educated, affluent, aristocratic family Tutored in mathematics, languages, religion, and philosophy (subjects later influenced the course of her work)  Florence Nightingale Notes on Nursing: What It Is and What It Is Not (1969, originally published in 1859) Her philosophy of health, illness, and the nurse’s role in caring for patients Patient’s health and recovery from illness is related to environment-cleanliness Importance of observing the patient and recording information She was addressed as the lady with lamp during the Crimean War Origin of Nightingale’s Environmental Concepts Nightingale believed that the environment could be altered to improve conditions so that the natural laws would allow healing to occur. This grew from empirical observation that poor or difficult environments led to poor health and disease. In her Crimean experience, filth, inadequate nutrition, dirty water, and inappropriate sewage disposal led to a situation in which more British soldiers died in the hospital than of battlefield wounds. Four metaparadigms: Four concepts of nursing theory A ) The person B) The environment C ) Health D ) Nursing 32 4 metaparadigms or concept of Nightingale’s theory Person: Nightingale refers to the person as an individual receiving care, and multidimensional (biological, psychosocial, and spiritual) human being. Nurses perform tasks to and for the patient and controlled the patient’s environment to enhance recovery. Health: Nightingale defined health as being well and using every power that the person has the fullest extent. She envisioned the maintenance of health through the prevention of disease via environmental control.  Environment: The elements external to and affect the health of the sick and healthy person. E.g. food, flowers, verbal and non-verbal interactions with the patient – Physical environment: Ventilation (fresh air), warm, quite/noise, cleanliness (personal hygiene, bedding, room, pure water, efficient drainage system), diet, light – Psychological environment: chattering hopes/ advices Let’s watch this video! Movie on Florence Nightangle (1 hour duration)-SDL Need Theory by Virginia Henderson  Virginia Henderson's Need Theory (1897-1996) Born in 1897 in Kansas City, United States 1981 entered Army school of nursing and graduated at 1921 Received (B.S degree 1931, M.A degree 1932) Has long carrier as author and researcher and both has clinical and teaching experiences in nursing Nursing is combination of art and science  Concepts of fundamental human needs, bio-physiology, culture, and interaction Her definition and concept are based on the 14 components of human needs. Published book, “Principles and Practices of Nursing” in 1932 It has been published in 27 languages by the International Council of Nurses. 4 metaparadigm of Henderson’s theory Person: Viewed as patient who requires assistance to achieve health and independence, or peaceful death an individual in which mind and body are inseparable and consider all components; biological, psychological, sociological, and spiritual. Environment-All external conditions which influences life and development of a person. 41 4 metaparadigm of Henderson’s theory Health-Definition based on individual’s ability to function independently as outlined in the 14 components. Nursing Temporarily assisting an individual who lacks the necessary strength, will and knowledge to satisfy 1 or more of 14 basic needs. Need to have knowledge of biological and social sciences and skills 42 Now open your history taking form @ case study Case Study Form_4 March 2022 (1).docx Go to ACTIVITIES OF DAILY LIVING Observe the domain Next, open this journal and refer to the case study 23_ahtisham.pdf  Dorothea Orem (1914-2007) One of foremost nursing theorists who develop a grand nursing theory Born 1914 in Baltimore, USA Earned her diploma at Providence Hospital – Washington, DC 1939 – BSN Ed., Catholic University of America 1945 – MSN Ed., Catholic University of America  Dorothea Orem (1914-2007) Involved in nursing practice, nursing service, and nursing education During her professional career, she worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant Received honorary Doctor of Science degree in 1976 Published first formal articulation of her ideas in Nursing: Concepts of Practice in 1971 and subsequently in 1980, 1985, 1991, 1995, and 2001.  SELF CARE DEFICIT THEORY The basic focus of the model is that individuals should be self-reliant (ability for self care), and responsible for their health and others in their family needing care (their dependents) Self care and dependent care are behaviors learned within a socio-cultural context. Person self-care deficits are the result of environmental situations.  A person’s knowledge of potential health problems is necessary for promoting self-care behaviors. 47  Orem’s Self-Care Model Aimed at helping clients direct and carry out activities that either help maintain or improve their health Health is the responsibility of each individual!  Orem’s Self-Care Model Client: -the biologic, psychological and social being with the capacity for self-care -’self-care’: practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being Health: -the person’s ability to live fully within a particular physical, biologic and social environment, achieving a higher level of facing ’healthy’: living life to the fullest with the capacity to maintain life through self-care  Orem’s Self-Care Model Environment: -the medium through which clients move as they conduct their daily activities -generally viewed as a negative factor on a person’s health status because they may detract from the ability to provide self- care Nursing: -goal: help client conduct self-care activities in order to reach optimum level of functioning -methods: wholly compensatory -ICU partially compensatory- post op supportive/ educative- new dx ISLAMIC PERSPECTIVES https://sunnah.com/search?q=ablution  ISLAMIC PERSPECTIVES “Truly, Allah loves those who turn to Him constantly and He loves those who keep themselves pure and clean.” (Al Baqarah 2:222). https://news.iium.edu.my/?p=67490  TAKE HOME MESSAGE Najwa, M. (2015, April 10). Know the principles of cleanliness in Islam. IIUM Today. https://news.iium.edu.my/?p=67490. Siti Noorkhairina, S. (2023, October 1). Strok: Gejala dan Tip Jagaan Pesakit di Rumah. Pertubukan IKRAM Malaysia. https://ikram.org.my/strok-gejala-dan-tip- jagaan-pesakit-di-rumah/ Siti Noorkhairina, S. (2023). TIP JAGAAN KENDIRI: Pesakit Kanser Reproduktif. https://indiework.usm.my/index.php?route=product/produ ct&product_id=557  SELECTED NURSING THEORIES (2nd PART) Nightingale’s Theory (Environment) Virginia Henderson (Activity of Daily Livings) Orem’s Theory (Self-care) Leininger’s Theory (Transcultural) Watson’s Theory (Caring) Roy’s Theory (Adaptation) Peplau’s Theory (Interpersonal relation)  REVISIT: Types of Theory Theories have different purposes and classified by level of abstraction or the goals of the theory as follows:- 1. Grand theories: Systematic and broad in scope, complex & therefore require further specification through research. E.g. Neuman’s system model 2. Middle range theories: Limited in scope and more abstract that address specific phenomena & reflect practice in administration, clinical or teaching. E.g. Issues on incontinence or uncertainty by Mishel’s (1990) 3. Descriptive theories: The first level of theory development which do not direct specific nursing activities but help to explain nursing assessment. 4. Prescriptive theories: Addresses nursing interventions for a phenomenon, describe the conditions under which the prescription occurs & predict the consequences. E.g. Effective decision-making: applying the theories to nursing practice by Watkins (2020). Madeleine Leininger  The founder of the theory of Transcultural Nursing / Culture Care Theory  Her theory has now developed as a discipline in nursing.  Evolution of her theory can be understood from her books:  Culture Care Diversity and Universality (1991)  Transcultural Nursing (2002)  Transcultural Nursing (1995)  Theoretical framework is depicted in her model called the Sunrise Model (1997).  Transcultural Theory in Nursing A humanistic and scientific area of formal study and practice in nursing which is focused upon differences and similarities among cultures with respect to human care, health, and illness based upon the people's cultural values, beliefs, and practices to use this knowledge to provide nursing care to people based on specific cultures. Transcultural Nursing A comparative study of cultures to understand similarities (culture universal) and differences (Culture-Specific) across human groups (Leininger, 1991). SDL: What is culture?  Goal of Transcultural Nursing “to give culturally congruent nursing care, and to provide culture specific and universal nursing care practices for the health and well- being of people or to aid them in facing adverse human conditions, illness or death in culturally meaningful ways.”  Major Assumptions Illness and wellness are shaped by various factors including perception and coping skills, as well as the social level of the patient. Cultural competence is an important component of nursing. Culture influences all spheres of human life. It defines health, illness, and the search for relief from disease or distress. Religious and cultural knowledge is an important ingredient in health care.  Major Assumptions The health concepts held by many cultural groups may result in people choosing not to seek modern medical treatment procedures. Health care providers need to be flexible in the design of programs, policies, and services to meet the needs and concerns of the culturally diverse population, and groups that are likely to be encountered. Most cases of lay illness have multiple causalities and may require several different approaches to diagnosis, treatment, and cure including folk and Western medical interventions.  Major Assumptions The use of traditional or alternate models of health care delivery is widely varied and may come into conflict with Western models of health care practice. Culture guides behavior in acceptable ways for the people in a specific group as such culture originates and develops within the social structure through inter-personal interactions. For a nurse to successfully provide care for a client of a different cultural or ethnic background, effective intercultural communication must take place.  Application to Nursing To develop understanding, respect, and appreciation for the individuality and diversity of patients’ beliefs, values, spirituality, and culture regarding illness, its meaning, cause, treatment, and outcome. To encourage in developing and maintenance of a program of physical, emotional, and spiritual self-care introduce therapies such as ayurveda and Pancha karma. Application in Malaysia Context https://hq.moh.gov.my/tcm/en/index.php/profil/tcmunit Application in Malaysia Context http://www.myhealth.gov.my/pemakanan-semasa-berpantang/ THEORY OF HUMAN CARING (JEAN WATSON) Watson proposes 7 assumptions about the science of caring: 1. Caring can be effectively demonstrated and practiced only interpersonally. 2. Caring consists of curative factors that result in the satisfaction of certain human needs. 3. Effective caring promotes health and individual or family growth. 4. Caring responses accept a person not only as he or she is now but as what he or she may become. 5. A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself at a given point in time. 6. Caring is more “health organic” than curing. A science of caring is complementary to the science if curing. 7. The practice of caring is central to nursing.  Ten curative factors/Caritas Process as philosophical foundations for science of caring https://youtu.be/jRvNYuhKxBA?si=piwUJD6CUqu1-iZO  Ten curative factors as philosophical foundations for science of caring 1. The formation of a humanistic- 6. The systematic use of the scientific altruistic system of values. problem-solving method for decision 2. The installation of faith-hope. making. 7. The promotion of interpersonal 3. The cultivation of sensitivity to teaching-learning. one’s self and to others. 8. The provision for a supportive, 4. The development of a helping trust protective, and/or corrective mental, relationship physical, socio-cultural, and spiritual 5. The promotion and acceptance of environment. the expression of positive and 9. Assistance with the gratification of negative feelings. human needs. 10. The allowance for existential- phenomenological forces.  Nursing Metaparadigm: four concepts The Human Being: Basic to the Theory of Caring a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted a person as a fully functional integrated self & viewed as greater than and different from, the sum of his or her parts Health: a general adaptive-maintenance level of daily function absence of illness or the process of efforts that will lead to an absence of illness includes a high level of overall physical, mental, and social function. Environment / Society:  Includes immediate and extended family, community and culture  Setting for nursing care, means of learning caring, interrelation and coping mechanisms Nursing A science of human relationships & caring can be demonstrated and practiced by the nurses Parallels the scientific research and nursing process; assessment (observation, identification and review of the problem, and the formulation of a hypothesis). Creates a care plan (determine how variables will be examined) Data collection, intervention (the implementation of the developed plan) and evaluation (examination and the interpretation of the results) Watson’s hierarchy of needs To assist with the gratification of human needs; 1.Lower-order biophysical needs include food and fluid, elimination, and ventilation. 2.Lower-order psychophysical needs include activity- inactivity and sexuality. 3.Higher-order psychosocial needs include achievement, affiliation, intrapersonal-interpersonal need, and self- actualization.  APPLICATION OF THE THEORY OF HUMAN CARING (JEAN WATSON) IN NURSING PRACTICE 1. Skill-set for building rapport with client 2. Caring attitude to be cultivated in nursing practice and at the workplace (clinical/education/management) https://youtu.be/rGv_hDJetYI?si=gFw7D1-guAvQKluo  Development of the Model Roy believed that the environment and the individual are sources of stimuli that require modification to promote adaptation in the patient. Adaptation is defined as a “process and outcome whereby thinking and feeling persons, as individuals or groups, use conscious awareness and choice to create human and environmental integration. Adaptation is manifested by four interrelated modes of behavior including physiological, self-concept, role function & interdependence modes. 1. Any of these can be considered a human system. 2. It combines the concept of system and adaptation. 3. Human adaptive system has input coming from external env. as well as from within the system. 4. Stimuli are conceptualized as falling into 3 classifications - focal, contextual and residual. APPLICATION OF THE ROY’S ADAPTATION THEORY IN NURSING PRACTICE THANK YOU! INTERPERSONAL RELATIONS IN NURSING Stresses the importance of nurses’ ability to understand their own behaviors to help others identify perceived difficulties. Emphasizes the focus on the interpersonal processes and therapeutic relationship that develops between the nurse and client. a) Four phases of the nurse-patient relationship are identified b) Six primary roles of the nurse c) Six secondary roles of the nurse  4 Phases of nurse-patient relationship 1) Orientation: Client seeking 3) Exploitation: The patient attempts assistance, meeting of nurse- to explore, understand, and deal patient, identifying the problem with the problem and gains and services needed (interview process), and guidance. independence in achieving the goal 2) Identification: Identifying who 4) Resolution: termination of the is best to support needs, patient therapeutic relationship to addresses personal feelings encourage emotional balance for about the experience and is nurse and patient (difficult for both encouraged to participate in care to promote personal acceptance patient and nurse as psychological and satisfaction. dependence persists)  Roles of Nurses Primary Secondary a. Stranger a. Technical expert b. Teacher b. Mediator c. Resource person c. Safety agent d. Counselor d. Researcher e. Surrogate e. Tutor f. Leader f. Manager of environment  Different Nursing Roles Assumed During The Various Phases Of Nurse -Patient Relationship a) Stranger: Receives the client in the same way one meets a stranger in other life situations. provides an accepting climate that builds trust. b) Teacher: Who imparts knowledge in reference to a need or interest. c) Resource person: One who provides specific needed information that aids in the understanding of a problem or new situation. d) Counselors: Help to understand and integrate the meaning of current life circumstances. Provide guidance and encouragement to make changes. e) Surrogate: Helps to clarify domains of dependence, interdependence, and independence and acts on the client’s behalf as an advocate. f) Leader: Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way.  PEPLAU’S THEORY AND NURSING’S METAPARADIGM Person According to Peplau, it is defined as an organism that “strives in its own way to reduce tension generated by needs“. Health It is defined as a word symbol that implies a forward movement of personality and other ongoing human processes in the “ direction of creative, constructive, productive, personal, and community living.” 7 Environment Peplau defined“ it in terms of existing forces outside the organism and in the context of culture Nursing “It is 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 especially educated to recognize and to respond to the need for help.”  MAJOR CONCEPTS OF PEPLAU’S THEORY 1. Nurses should apply principles of human relations to the problems that arise at all levels of experience. 2. Peplau’s theory explains the phases of interpersonal process, roles in nursing situations, and methods for studying nursing as an interpersonal process. 3. Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of healthcare. 4. Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal. 5. The attainment of goal is achieved through the use of a series of steps following a series of pattern. 6. The nurse and patient work together so that both become mature and knowledgeable in the process.  ELEMENTS INVOLVED IN NURSE-PATIENT RELATIONSHIP Contract  The time, place and purpose of meetings as well as conditions for termination are established between the nurse and the client. Boundaries  Roles of participants are clearly defined, the nurse is defined as a professional helper, and the client’s needs and problems focus of the interaction. Confidentiality The nurse should share information only with professional staff who need to know. The nurse should obtain the client’s written permission to share information with others outside the treatment team. Therapeutic Nurse Behaviors i. Self-awareness iv. Empathy ii. Genuineness v. Cultural sensitivity iii. Warmth and respectfulness vi. Responsibility vii. Ethical practice APPLICATION OF THE INTERPERSONAL RELATIONS BY PEPLEAU https://youtu.be/4Qon7nD3ISY?si=0Blfyt_d31EaZoYv WE HAVE COVERED ALL FOLLOWING THEORIES:- Nightingale’s Theory (Environment) Virginia Henderson (Activity of Daily Livings) Orem’s Theory (Self-care) Leininger’s Theory (Transcultural) Watson’s Theory (Caring) Roy’s Theory (Adaptation) Peplau’s Theory (Interpersonal relation)  PREVIOUS LECTURE MAJOR THEORY IN NURSING:- 1. Leininger’s Culture Care Theory and Sunrise Model 2. Family Health System (FHS) 3. Developmental Theories OTHER RELEVENT THEORIES (BORROW FROM OTHER FIELD):- Health Belief Model Protection Motivation Theory Self-efficacy Theory Theory of Reasoned Action Theory of Planned Behavior Theories of Grief & Mourning  CONCLUSION Theoretical foundation is vital to govern the practice in Nursing. Apart of that, theory is used to support many aspects in nursing education and research to give a clear focus and aim accordingly. Each theory is unique and only explains certain elements of interest.  REFERENCES Required 1. Chitty, K. K. & Black, B. P. (2020). Professional Nursing: Concepts and Challenges (9th ed.). United States of America: Saunders. 2. Potter, P., Perry, A., Stockert, P. & Hall, A. (2021). Fundamentals of Nursing. Elsevier: Missouri. Recommended 1. Akta Jururawat. (1950). Regulatory review management system. Available: http://rr.mpc.gov.my/data/license-legal-525f8cd228947.pdf. Retrieved [Accessed 20042016] 2. Berman, A. & Snyder, S. (2016). Kozier & Erb’s Fundamentals of Nursing: Concepts, process and practice (10th ed.). United States of America: Pearson. 3. Burkhard, M & Nathaniel, A. (2020). Ethics & Issues in Contemporary Nursing: Nursing Ethics in the 21st Century. Missouri: Elsevier. 4. Grace, P. (2018). Nursing Ethics and Professional Responsibility in Advance Practice (3rd ed.). United States of America: Jones & Bartlett Learning  REFERENCES Journals Biamonti M. (1998). Les 14 besoins fondamentaux... selon Virginia Henderson [Virginia Henderson's "14 fundamental necessities". Interview by O Burrus]. Revue de l'infirmiere, (42), 55–58. Watkins S. (2020). Effective decision-making: applying the theories to nursing practice. British journal of nursing (Mark Allen Publishing), 29(2), 98–101. https://doi.org/10.12968/bjon.2020.29.2.98 ANY QUESTIONS?