Nursing Theory What is it? Deanna B Hiott MSN,RN
Nursing DomainA domain is a specific area of expert knowledge.Thedomain of nursing describes the profession’ssubject, concepts, values, and beliefs.Nursing’s domain is the profession itself, past, present,future…
The Nursing Paradigm… A paradigm is a model. It describes the domain using science, philosophy and theory. Nursing’s paradigm involves person, health, environment and nursing.Environment – setting affecting client, family, communityHealth – dynamic, changing, individualNursing Care – treatment of human responses to illnessPerson – recipient of care, individual, family, community
Nursing TheoriesAre composed of concepts, definitions andproposals to explain phenomenon.A phenomenon is an aspect of life that peopleexperienceNursing theories provide the lens through whichnursing care and interventions are viewedDifferent theories emphasize different areas ofcare or concern
Nursing Theories can be described as…Descriptive: First level, describe phenomenaPrescriptive: Address nursing interventionsMid-Range: Limited, less abstract, reflect a widevariety of nursing situationsGrand: Broad, complex, addresses nursingframework not specific interventions
Common Nursing Theories Nightingale (1860) fresh air, light, cleanliness, quiet and proper nutrition Peplau (1952) Interpersonal Relations Theory, mutual goal setting Virginia Avenal Henderson (1955) 14 basic human needs. Martha Rogers Science of Unitary Human Beings (1970) Betty Neuman (1972) Systems Theory
Common Nursing Theories Orem’s Self Care Deficit Theory (1971) Leininger’s Culture Care Theory (1991) Sister Calista Roy’s Adaptation Theory focuses on helping the client adapt to health changes Watson’s Theory of Human Caring 1979(Potter & Perry, 2009)
Nurses also use interdisciplinary theories... Maslow’s Hierarchy of Needs –Helps prioritize care Developmental theories – Piaget, Erikson… Helps anticipate care Psychosocial theories - grief, culture, learning, familyHelps predict care
What’s the point?Over the years nurses have attempted to definenursing. From these efforts, numerous theorieshave emerged. Many might consider thesetheories rather dry material, and in all honesty,this was probably my first conclusion as well. As Istudied nursing theorists, I felt confused by thelanguage. I was at a loss to see the purpose.However, for any students grappling with thesesame feelings, I would like to encourage you.The more you study them, the more youappreciate these nurses who spent a great dealof time and effort defining our profession, forultimately this is what delineates a science.
Assessing Nursing TheoriesTheory relevance can be assessed by applyingthe theory to a patient care situationThe nursing paradigm of environment, health,nursing care and person are examined
An example of a theorist’s paradigm.Definitions of person, nurse, health and environment According to Myra Estrine Levine (Conservation Theory) : "From the moment of birth until the instant of death, every individual cherishes and defends his wholeness. "(Schaefer, Pond 1991, p. 17) Health represents the "unity and integrity of the patient." (George,p.185) "Nursing is a human interaction" based on the goal of promoting wholeness for that individual. (Schaefer, Pond, 1991,p. 23) A patients environment is internal and external.
Nursing Interventions based on a nursing theory Myra Estrine Levine’s Conservation Theory views nursing care through the lens of conservation… 1) The conservation of energy 2) The conservation of structural integrity 3) The conservation of personal integrity 4) The conservation of social integrity(George, 1990)
Research can test the application of Nursing Theory Levines theory has been tested in several different nursing situations: to mitigate fatigue in cancer patients to wean patients off the ventilator to preserve and protect the infant and the family in the neonatal intensive care unit (NICU).
ENVIRONMENTAL INFLUENCES ON PRETERM INFANT Development of a healthy fetus should occur in an intrauterine environment, when this process is interrupted the neonate must conform to environmental factors including: Perceptual Environment: Instead of the dark, quiet fluid-filled environment, the neonate must adjust to the NICUs complex sensory stimuli, such as light, noise, people and equipment. Operational Environment: The neonate has been removed from the protection of the uterus, placing the infant at risk for infection, and a reduced muscle mass Conceptual Environment: CNS competence depends on the gestational age at delivery. Neonates must quickly learn how perform oral feedings and interact with family.
HEALTH (WHOLENESS) INFLUENCES ON PRETERM INFANTS Physiologic immaturity: Neonates must use energy adapt to underdeveloped respiratory, gastrointestinal, and central nervous systems. Structural immaturity: Neonates must confront increased risks of infections, toxic effects of oxygen administration, retinal detachment, GI disorders, brain injury, musculoskeletal abnormalities. Neurologic Immaturity: Sense of identity can be affected. Disruption in Family System: Challenges include grieving the loss of the healthy infant, disruption of bonding, parenting a special needs child, social identity.(Mefford, 2004)
NURSING INFLUENCES PRETERM INFANTSConservation of Energy: oxygen, ventilation, airway integrity, breathing assessments provide calm environment, promote rest, pain control, temperature regulation provide nutrition: parenterally, g-tube, orally
NURSING INFLUENCES PRETERM INFANTS Conservation of Structural Integrity: Promote optimal oxygenation while minimizing need for supplemental o2 Stabilize blood pressure; calm environment, comfort Prevent infections; hand hygiene, aseptic technique, maintain skin integrity Monitor internal feedings for tolerance Promote flexed posture(Mefford, 2004)
NURSING INFLUENCES PRETERM INFANTS Conservation of Personal Identity: Interpret physiologic cues (vs, labs, physical assessment findings) Effectively communicate with the neonate, by recognizing the response: read the message Minimize signs of stress Promote self-regulating behavior(Levine, 1973)(Mefford, 2004)
NURSING INTERVENTIONS PRETERM INFANTS Conservation of Social Integrity: Modifying NICU to welcome families and promote parental comfort Assist parents through grief of loss of having a healthy infant Provide support to family to cope with NICU experience Foster parent-infant attachment Facilitate parent performance of infant care Ensure infant and familys readiness for discharge from the NICU(Mefford, 2004)
Links to Nursing Theoryhttp://nursingclass2.wikispaces.com/Nursing+Theoristshttp://currentnursing.com/nursing_theory/introduction.htmlhttp://nursing-theory.org/
BibliographyAlligood, Martha; Ann Marriner-Tomey. (1997). Nursing Theory Utilization and Application. St. Louis: Mosby.Ann Marriner Tomey, Martha Raile Alligood. (1998). Nursing Theorists and Their Work (4th ed.). (L. Wilson, Ed.) St Louis:Mosby.Delmore, B. A. (2006). Levines Framework in Long-Term Ventilated Patients During the Weaning Course. NursingScience Quarterly , 19 (3), 247-258.George, J. B. (Ed.). (1990). Nursing Theories: The Base for Professional Nursing Practice (3rd ed.). Norwalk, Connecticut:Appleton and Lange.Kathleen Sitzman, Lisa Wright Eichelberger. (2004). Understanding the Work of Nurse Theorists : A Creative Beginning.Sudbury, Massachusetts: Jones and Bartlett Publishers, Inc.Mefford, L. (2004). A Theory of Health Promotion for Preterm Infants Based on Levines Conservation Model of Nursing.Nursing Science Quarterly , 17 (3), 260-266.Melanie McEwen, Evelyn M. Wills. (2007). Theoretical Basis for Nursing (2nd ed.). (H. Kogut, E. Kors, & M. Zuccarini,Eds.) Philadelpia, PA: Lippincott Williams & Wilkins.Myra Levine, Jacqueline Fawcett. (1991). Levines Conservation Model: A Framework for nursing Practice. (K. M.Schaefer, & J. B. Pond, Eds.) Philadelphia: F.A.Davis Company.Victoria Mock, Christine St, Ours, Amy Bositis, Miriam Tillery, Anne Belcher, Sharon Krumm and Ruth McCorkle. (2007).Using a conceptual model in nursing research - mitigating fatigue in cancer patients. Journal of Advanced Nursing , 58 (5),503-512.