Download Nursing Theories: An Overview of Key Concepts and Models and more Study notes Nursing in PDF only on Docsity!
_______________
UNIVERSITY OF EASTERN PHILIPPINES
College of Nursing and Allied Health Sciences
NURSING THEORIES LESSON 5.
KEY TERMS:
Culture: refers to patterned lifeways, values, beliefs, norms, symbols, and practices of individuals, groups or institutions, that are shared, learned, and usually transmitted from one generation to another. Health: is the “pattern of the whole” of a person and includes diseases as a manifestation of the pattern of the whole, based on the premise that life is an ongoing process of expanding consciousness. Personal factors: categorized as biological, psychological, and socio-cultural. These factors are predictive of a given behavior and are shaped by the nature of the target behavior being considered. Lesson 5: Nursing Theories
1. Peplau’s Theory of Interpersonal
Relationship
Hildegard E. Peplau defined nursing as a a. therapeutic, b. interpersonal process which strives to develop a nurse- patient relationship in which the nurse serves as a resource person, counselor, and surrogate.
Introduced the Interpersonal Model.
Defined nursing as an interpersonal process of therapeutic between an individual who is sick or in need of health services and a nurse especially educated to recognize and respond to the need for help. Her work is influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller.
She identified four phases of the nurse client
relationship namely:
1. Orientation: the nurse and the client initially do not know each other’s goals and testing the role each will assume. The client attempts to identify difficulties and the amount of nursing help that is needed; 2. Identification: the client responds to help professionals or the significant others who can meet the identified needs. Both the client and the nurse plan together an appropriate program to foster health; 3. Exploitation: the clients utilize all available resources to move toward a goal of maximum health functionality; 4. Resolution: refers to the termination phase of the nurse-client relationship. it occurs when the client’s needs are met, and he/she can move toward a new goal. Peplau further assumed that nurse-client relationship fosters growth in both the client and the nurse.
2. ORLANDO’S THEORY OF DELIBERATIVE
NURSING PROCESS
Developed the Nursing Process Theory “Patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analysis with patients before drawing conclusions.” Allow 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 have an 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. Conceptualized The Dynamic Nurse – Patient Relationship Model. She believed that the nurse - helps patients meet a perceived need that the patient cannot meet for themselves. Orlando observed that the nurse provides direct assistance to meet an immediate need for help in order to avoid or to alleviate distress or helplessness. She emphasized the importance of I. validating the need and II. evaluating care based on observable outcomes
3. Travelbee’s Human to Human Relationship
Joyce Travelbee Postulated the Interpersonal Aspects of Nursing Model Advocated that the goal of nursing individual or family is; preventing or coping with illness, regaining health finding meaning in illness, or maintaining maximal degree of health. Further viewed that interpersonal process is a human-to-human relationship formed during illness and “experience of suffering States in her Human-to-Human Relationship Model that the purpose of nursing was to help and support and 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. Believed that a person is a unique, irreplaceable individual who is in a continuous process of becoming, evolving and changing. Note: Please see also Travelbee’s Theory of Spiritual Well-Being in Illness
4. Hall’s CORE, CARE, CURE
Lydia E. Hall developed the Care, Cure, Core Theory also known as the “Three Cs of Lydia Hall.”
Hall defined nursing as the “participation in
care, core, and cure aspects of patient care,
where CARE is the sole function of the nurse ,
whereas the CORE and CURE are shared with
the other members of the health.”
The major purpose of care is to achieve an
interpersonal relationship with the individual
that will facilitate the development of the
core.
The client is composed of the following
overlapping parts:
1. person (core),
2. pathologic state and treatment (cure) and
3. body (care)
Introduced the model of Nursing: What Is It?
Focusing on the notion that centers around
three components of
CARE,
CORE and
CURE.
1. Care
represents nurturance and is exclusive to
nursing.
Defines the primary role of a professional
nurse such as providing bodily care
2. Core
involves the therapeutic use of self and
emphasizes the use of reflection.
Is the patient receiving nursing care
3. Cure
focuses on nursing related to the
physician’s orders.
Core and cure are shared with the other
health care providers.
The aspect of nursing which involves the
administration of medications and
treatments
5. Faye Abdellah’s 21 Nursing Problems
Developed the 21 Nursing Problem 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.” Defined nursing as having a problem-solving approach with key nursing problems related to
- health needs of people
- developed list of 21 nursing-problem areas
behavior-specific cognitions and affect, and; 3) behavioral outcomes.
8. Leinenger’s Theory of Culture Care Diversity
and Universality
Developed the Transcultural Nursing Model / Culture Care Theory of Diversity & Universality She advocated that nursing is a -humanistic and scientific mode of helping a client through specific cultural caring processes (cultural values, beliefs and practices) to improve or maintain Leininger’s Culture Care Theory attempts 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, group’s, or institution’s cultural values, beliefs, and lifeways.” The intent of the care is to fit with or have beneficial meaning and health outcomes for people of different or similar culture backgrounds The Culture 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 to help them face handicaps or death.” Leininger’s model has developed into a movement in nursing care called transcultural nursing. In 1995, Leininger 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 with the goal of providing 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.” Leininger developed new terms for the basic concepts of her theory. The concepts addressed in the model are: o Care , which assists others with real or anticipated needs in an effort to improve a human condition of concern, or to face death. o Caring is an action or activity directed towards providing care. o Culture refers to learned, shared, and transmitted values, beliefs, norms, and lifeways to a specific individual or group that guide their thinking, decisions, actions, and patterned ways of living. o Culture Care is the multiple aspects of culture that influence and help a person or group to improve their human condition or deal with illness or death. o Culture Care Diversity refers to the differences in meanings, values, or acceptable forms of care in or between groups of people. o Culture Care Universality refers to common care or similar meanings that are evident among many cultures. o Nursing is a learned profession with a disciplined focus on care phenomena. o Worldview is the way people tend to look at the world or universe in creating a personal view of what life is about. o Cultural and Social Structure Dimensions include factors related to spirituality, social structure, political concerns, economics, educational patterns, technology, cultural values, and ethnohistory that influence cultural responses of people within a cultural context. o Health refers to a state of well-being that is culturally defined and valued by a designated culture. o Cultural Care Preservation or Maintenance refers to nursing care activities that help people from particular cultures to retain and use core cultural care values related to healthcare concerns or conditions. o Cultural Care Accommodation or Negotiation refers to creative nursing actions that help people of a
particular culture adapt or negotiate with others in the healthcare community in an effort to attain the shared goal of an optimal health outcome for patients of a designated culture. o Cultural Care Re-Patterning or Restructuring refers to therapeutic actions taken by culturally competent nurses. These actions help a patient to modify personal health behaviors towards beneficial outcomes while respecting the patient’s cultural values. The theory’s culturalogical assessment provides a holistic, comprehensive overview of the client’s background. The assessment addresses the following: o communication and language o gender considerations o sexual orientation o ability and disability o occupation o age o socioeconomic status o interpersonal relationships o appearance dress o use of space o foods and meal preparation and related lifeways Leininger proposes that there are three modes for guiding nurse’s judgments, decisions, or actions in order to provide appropriate, beneficial, and meaningful care: o preservation and/or maintenance; o accommodation and/or negotiation; and o 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. The Sunshine Model is Leininger’s visual aid to the Culture Care Theory.
9. Newman’s Theory of Health as Expanding
Consciousness
Margaret Newman focused on Health as Expanding Consciousness. She believed that humans is unitary in whom disease is a manifestation of the pattern of health. She defined consciousness as the information capability of the system which is influenced by o Time o space movement and is o ever – expanding. According to Newman, “ The theory of health as expanding consciousness (HEC) was stimulated by concern for those for whom health as the absence of disease or disability is not possible. The theory has progressed to include the health of all persons regardless of the presence or absence of disease. The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness – a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world.” How a disease manifests in an individual patient depends on the pattern of that patient, so the pathology of the disease exists before the symptoms appear. By this logic, the removal of the symptoms of the disease will not change the patient’s individual structure or pattern. The model also addresses the interrelatedness of time, space, and movement. Time and space are the temporal pattern of the patient, and have a complementary relationship. People are constantly changing through time and space, which is movement, which shows a unique pattern of reality. According to Newman , nursing is the “process of recognizing the patient in relation to the environment, and it is the process of the understanding of consciousness.” The nurse helps patients understand how to use the power they have within in order to develop a higher level of consciousness. Therefore, it helps to realize the process of disease, its recovery, and its prevention. Nursing is seen as a partnership between the nurse and patient, and both grow in the sense of higher levels of consciousness.
10. PARSE’S Theory of HUMAN Becoming
#2. Orlando’s Nursing Process
Conceptualized the Dynamic Nurse – Patient Relationship Model. She believed that the nurse -helps patients meet a perceived need that the patient cannot meet for themselves. Orlando observed that the -nurse provides direct assistance to meet an immediate need for help in order to avoid or to alleviate distress or helplessness. She emphasized the importance of a. validating the need and b. evaluating care based on observable outcomes.
Developed the Deliberative Nursing Process
Theory
She proposed that “patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions.” Orlando’s nursing theory stresses the reciprocal relationship between patient and nurse. What the nurse and the patient say and do affects them both. She views the professional function of nursing as finding out and meeting the patient’s immediate need for help. Described her model as revolving around the following five major interrelated concepts: function of professional nursing, presenting behavior, immediate reaction, nursing process discipline, and improvement. o The function of professional nursin g is the organizing principle. o Presenting behavior is the patient’s problematic situation. o The immediate reaction is the internal response. The nursing process discipline is the investigation into the patient’s needs. o And lastly, improvement is the resolution to the patient’s situation.
The Deliberative Nursing Process has five stages:
assessment, diagnosis, planning, implementation,
and evaluation.
o Nurses use the standard nursing process in
Orlando’s Nursing Process Discipline Theory to produce positive outcomes or patient improvement
o Orlando’s key focus was the definition of the
function of nursing.
o The model provides a framework for nursing,
but the use of her theory does not exclude nurses from using other nursing theories while caring for patients.
Orlando’s Deliberative Nursing Process
Theory
o One important thing that nurses do is converse with the patients and let them know what the plan of care for the day is going to be. However, regardless of how well thought out a nursing care plan is for a patient, unexpected problems to the patient’s recovery may arise at any time. o With these, the job of the nurse is to know how to deal with those problems so the patient can continue to get back and reclaim his or her well-being. o 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.
o Goal
o To develop a theory of
effective nursing practice.
The theory explains that the
role of the nurse is to find
out and meet the patient’s
immediate needs for help.
All patient behavior can be a
cry for help. Through these,
the nurse’s job is to find out
the nature of the patient’s
distress and provide the
help he or she needs.
12. Locsin’s Technological Competency as Caring
Rozzano Locsin
Assumptions:
Technological Competency as Caring in Nursing is a middle range theory grounded in Nursing as Caring (Boykin & Schoenhofer), 2001). It is illustrated in the practice of nursing grounded in the harmonious coexistence between technology and caring in nursing. The assumptions of the theory are: • Persons are caring by virtue of their humanness (Boykin & Schoenhofer, 2001). Persons are whole or complete in the moment (Boykin & Schoenhofer, 2001). • Knowing persons is a process of nursing that allows for continuous appreciation of persons moment to moment (Locsin, 2005). Technology is used to know wholeness of persons moment to moment (Locsin, 2004). Nursing is a discipline and a professional practice (Boykin & Schoenhofer, 2001).
Dimensions of Technological Value in the Theory
Technology as completing human beings to re formulate the ideal human being such as in replacement parts, both mechanical (prostheses) or organic (transplantation of organs.) Technology as machine technologies, e.g. computers and gadgets enhancing nursing activities to provide quality patient care such as Penelope or Da Vinci in the Operating Theatres; Technologies that mimic human beings and human activities to meet the demands of nursing care practices, e.g. cyborgs (cybernetic organisms) or anthropomorphic machines and robots such as ‘nursebots’ (Locsin & Barnard, 2007).
Technological Competency as Caring in Nursing
Technological competency as caring in nursing is the harmonious coexistence between technologies and caring in nursing. The harmonization of these concepts places the practice of nursing within the context of modern healthcare and acknowledges that these concepts can co-exist. Technology brings the patient closer to the nurse. Conversely, technology can also increase the gap between the nurse and nursed. When technology is used to know persons continuously in the moment, the process of nursing is lived.
The Process of Nursing
A. Knowing : The process of knowing person is guided by technological knowing in which persons are appreciated as participants in their care rather than as objects of care. The nurse enters the world of the other. In this process, technology is used to magnify the aspect of the person that requires revealing - a representation of the real person. The person’s state change moment to moment - person is dynamic, living, and cannot be predicted. B. Designing : Both the nurse and the one nursed (patient) plan a mutual care process from which the nurse can organize a rewarding nursing practice that is responsive to the patient’s desire for care. C. Participation in appreciation: The simultaneous practice of conjoined activities which are crucial to knowing persons. In this stage of the process is the alternating rhythm of implementation and evaluation. The evidence of continuous knowing, implementation and participation is reflective of the cyclical process of knowing persons. D. Verifying knowledge: The continuous, circular process demonstrates the ever-changing, dynamic nature of knowing in nursing. Knowledge about the person that is derived from knowing, designing, and implementing further informs the nurse and the one nursed.
13. LEVINE’S The CONSERVATIONAL MODEL
According to Myra Estrin Levine’s Conservational Model , “Nursing is human interaction.” Provides a framework within which to teach beginning nursing students.
In this nursing theory, a patient does not need
to be ill or injured since health education
qualifies someone as a patient.
The nurse is a functioning human being who not only acts, but thinks and feels. A nurse uses his or her knowledge in his or her role. Knowledge encompasses all that has been perceived and grasped by the human mind. It may be factual, speculative, or practical. The Helping Art of Clinical Nursing addresses the definition of a person , as well. The theory states that each person, whether a nurse or patient, has a unique potential to develop self-sustaining resources. People tend to be independent and fulfill their own responsibilities. In Wiedenbach’s theory, self-awareness and self- acceptance are essential to personal integrity and self-worth ; whatever an individual does at any given moment is representative of the best judgment available for that person in that moment. 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. Wiedenbach identifies four main elements of clinical nursing. They are a philosophy, a purpose, a practice, and the art.
- The nurse’s philosophy is his or her attitude and belief about life and how that attitude affected his or her reality. The three essential components associated with nursing philosophy are a 1. reverence for life; 2. respect for the dignity, worth, autonomy, and individuality of each human being; and a 3. resolution to act on personally and professionally held beliefs.
- A nurse’s purpose is that which the nurse wants to accomplish through what he or she does It is all the activities directed toward the overall good of the patient. The practice of nursing is the observable actions that are affected by the nurse’s beliefs and feeling about meeting the patient’s need for help. 3. The art of nursing includes understanding a patient’s needs and concerns, developing goals and actions intended to enhance a patient’s ability, and directing the activities related to the medical plan to improve the patient’s condition. The nurse also focuses on prevention of complications that can come up due to re- occurrence, or the development of new concerns.
15. Peterson & Zderad’s The Humanistis Model
Josephine Peterson and Loretta Zderad (1976) created the Humanistic Model Humanistic nursing theories have a foundation in the belief that patients can grow in a healthy and creative way. They believed that nursing education should be founded in experience, and that a nurse’s trainin g should focus as much on the nurse’s ability to relate to and interact with patients as a scientific and medical background. Emphasis on the nurse-patient relationship , in which both people influence the outcome of the nursing interventions. The function of the nursing approach shows that the relationship between the nurse and patient has as much to do with the patient’s healing as medical interventions. Humanistic nursing focuses closely on how the relationship between the patient and nurse develops in addition the patient’s physical and mental health. The humanistic model of nursing looks at the patient as an individual , and each situation as unique. In this nursing approach, there is no formulaic method or process in order to care for patients. Each patient is assessed and treated on a case-by- case basis The Humanistic Model of Nursing is an approach to nursing that encompasses a number of individual theories, including Patricia Benner’s From Novice to Expert Model of Nursing and Jean Watson’s Theory of Caring.
16. Erickson, Tomlin, and Swain (1983) Theory of
Modeling and Role-Modeling
Modeling and Role Modeling theory was developed by Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain The theory was published in their book Modeling and Role Modeling: A Theory and Paradigm for Nursing, in 1983. This theory is considered as a philosophy of nursing. The Theory of Modeling and Role-Modeling ( Erickson , Tomlin , & Swain , 1983 ) enables nurses to care for and nurture each client with an awareness of and respect for the individual's uniqueness. This type of care giving exemplifies theory -based clinical practice that focuses on the clients' needs (Sappington, 1996). The Theory draws concepts from Maslow's theory of hierarchy of needs Erikson's theory of psychosocial stages Piaget's theory of cognitive development General Adaptation Syndrome (GAS) by Selye and Lazarus COMMONALITIES AND DIFFERENCES (BARBARA L. IRVIN, 1997) The theory explains about some commonalities and differences among people. Commonalities among people are:
- Holism
- Basic Needs
- Affiliated-Individuation
- Attachment and Loss
- Psychosocial Stages
- Cognitive Stages Differences among people are:
- Inherent Endowment
- Model of the World
- Adaptation
- Adaptation Potential
- Stress
- Self-Care
- Self-Care Knowledge
- Self-Care Resources
- Self-Care Action MODELING Modeling is the process by which the nurse seeks to know and understand the client’s personal model of his or her world and learns to appreciate its value and significance. Modeling recognizes that each person has a unique perspective (model) of his or her world. The nurse uses this process to develop an image and understanding of the client’s world from the client’s perspective. ROLE MODELING Role modeling is the process by which the nurse facilitates and nurtures the individual in attaining, maintaining, and promoting health. Role modeling accepts the client unconditionally and allows planning of unique interventions. According to this concept, the client is the expert in his or her own care and knows best how he or she needs to be helped. According to the theory the roles of nursing are:
- Facilitation
- Nurturance
- Unconditional Acceptance
- The theory states five goals of nursing interventions as:
- Build trust
- Promote client’s positive orientation
- Promote client’s control
- Affirm and promote client’s strengths
- Set mutual, health-directed goals Modeling refers to the development of an understanding of the client's world. Role modeling is the nursing intervention, or nurturance, that requires unconditional acceptance. This model considers nursing as a self-care model based on the client's **perception of the world and adaptations to stressors.
- Kolcaba’s Comfort Theory** Katharine Kolcaba’s Theory of Comfort was first developed in the 1990s. It is a middle-range theory for health practice, education, and research. This theory has the potential to place comfort in the forefront of healthcare. According to the model, comfort is an immediate desirable outcome of nursing care. Kolcaba's theory of comfort explains comfort as a fundamental need of all human beings for relief, ease, or transcendence arising from health care situations that are stressful. Comfort can enhance health-seeking behaviors for patients, family members, and nurse Kolcaba described comfort existing in three forms : relief, ease, and transcendence.
