1. Nursing Theories andFrameworks GENALYN B. CIRINEO, RN, MSN
2. NURSING THEORIES 1. Florence Nightingale Developed and described the first theory of nursing. She focused on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act. She believed that in the nurturing environment, the body could repair itself.
3. 2. Faye Abdellah Identified 21 nursing problems. She defined nursing as service to individuals and families; therefore to society. Furthermore, she conceptualized nursing as 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.
4. 21 NURSING PROBLEMS 1. To promote good hygiene and physical comfort 2. To promote optimal activity, exercise, rest, and sleep 3. To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection 4. To maintain good body mechanics and prevent and correct deformities 5. To facilitate the maintenance of a supply of oxygen to all body cells 6. To facilitate the maintenance of nutrition of all body cells 7. To facilitate the maintenance of elimination
5. 8. To facilitate the maintenance of fluid and electrolyte balance 9. To recognize the physiologic responses of the body to disease conditions 10. To facilitate the maintenance of regulatory mechanisms and functions 11. To facilitate the maintenance of sensory function 12. To identify and accept positive and negative expressions, feelings, and reactions 13. To identify and accept the interrelatedness of emotions and organic illness 14. To facilitate the maintenance of effective verbal and nonverbal communication
6. 15. To promote the development of productive interpersonal relationships 16. To facilitate progress toward achievement of personal spiritual goals 17. To create and maintain a therapeutic environment 18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs 19. To accept the optimum possible goals in light of physical and emotional limitations 20. To use community resources as an aid in resolving problems arising from illness 21. To understand the role of social problems as influencing factors in the cause of illness
7. NURSING THEORIES3. Virginia Henderson (1960) Identified 14 basic needs. Shepostulated that the unique function of thenurse is to assist clients, sick or well in theperformance of those activities contributingto health, its recovery, or peaceful deaththat clients would perform unaided if theyhad the necessary strength, will orknowledge.
8. 14 BASIC NEEDS1. breathe normally.2. eat and drink adequately.3. eliminate body wastes.4. move and maintain desirable postures.5. sleep and rest.6. select suitable clothes--dress and undress.7. maintain body temperature within normalrange by adjusting clothing and modifying the environment.
9. 8. keep the body clean and well groomed andprotect the integument.9. avoid dangers in the environment and avoidinjuring others.10. communicate with others in expressingemotions, needs, fears or opinions.11. worship according to ones faith.12. work in such a way that there is a sense ofaccomplishment.13. play or participate in various forms of recreation.14. learn, discover, or satisfy the curiosity that leadsto normal development and health and use theavailable health facilities.
10. 4. Dorothy E. Johnson Conceptualized the Behavioral SystemModel for nursing w/c has 7 subsystems: 1. attachment/affiliation 2. dependence 3. ingestive 4. eliminative 5. sexual 6. aggressive 7. achievement
11. 5. Imogene king Postulated the Goal Attainment Theory. Shedescried nursing as a helping profession that assistindividual and group in society to attain, maintain,and restore health. If this is not possible, nurse helpindividual to die with dignity. In addition, King viewed nursing as aninteraction process between client and nursewhereby during perceiving, setting goals, andacting on them, transactions occur and goal areachieved.
12. 6. Madeleine Leininger Developed the Transcultural Nursing Model.She advocate that nursing is a humanistic andscientific mode of helping a client throughspecific cultural caring process (cultural values,beliefs and practices) to improve or maintain ahealth condition.
13. 7. Myra Levine described the Four Conservation Principles. Sheadvocated that nursing is a human interaction andproposed four conservation principles of nursing whichare concerned with unity and integrity of the individual.The four conservation principles are as follows:(1)conservation of energy. The human body functionsby using energy. The human body needs energyproducing input. (food, oxygen, fluids) to allow energyutilization as an output. (2) conservation of Structuralintegrity. The human body has physical boundaries (skinand mucous membrane)that must be maintained tofacilitate health and prevent harmful agents fromentering the body.
14. (3) conservation of Personal Integrity. The nursing intervention are base on the conservation of an individual clients personality. Every individual has sense of identity, self-worth and self-esteem, which must be preserved and enhanced by nurses. (4) Conservation of Social Integrity. The social integrity of the client reflects the family and the community in which the client functions. Health care institutions may separate individuals from their family. It is important for nurses to consider the individual in the context of the family.
15. NURSING THEORIES8. Betty Neuman proposed the Health Care System Model.She asserted that nursing is a unique professionin that ii is concerned with all the variablesaffecting an individual’s response to stresses,which are intra- (within the individual), inter-(between one or more other people), and extrapersonal (outside the individual) in nature Theconcern of nursing is to prevent stress invasion,to protect the client’s basic structure andobtain or maintain a maximum level of wellness.The nurse helps the client through primary,secondary and tertiary prevention modes, toadjust to environmental stressors and maintainclient system stability.
16. NURSING THEORIES9. Dorothea Orem developed the Self-Care and Self-Care Deficit Theory. She define self-care as“the practice of activities that individualinitiate and perform on their own behalf inmaintaining life, health and well-being.” sheconceptualized three nursing system asfollows: (1) wholly Compensatory: when thenurse in expected to accomplish all thepatient’s therapeutic self-care or tocompensate for the patient’s inability toengage in self-care or when the patientneed continuous guidance in self-care;
17. (2) Partially Compensatory: when bothnurse and patient engage in meeting self-care needs; (3)Supportive-Educative: thesystem that requires assistance in decisionmaking, behavior control and acquisition ofknowledge and skills.
18. NURSING THEORIES10. Hildegard Peplau Introduced that Interpersonal Model.She defined nursing as interpersonal processof therapeutic interactions between anindividual who is sick or need of healthservices and a nurse especially educatedto recognize and respond to the need forhelp. She identified four phases of thenurse-client relationship namely:( 1)orientation: the nurse and the client initiallydo not now each other goals and testingthe role each will assume. The clientattempts to identify difficulties and theamount of nursing help that is needed;
19. Identification: the client respond to theprofessionals or the significant others whocan meet the identified needs. Both theclient and the nurse plan together anappropriate program to foster health;(3)exploitation the client utilized all availableresources to move toward the goal ofmaximal health or functionality; (4)resolution: refers to the termination phase ofthe nurse client relationship. It occurs whenthe clients needs are met and he/she canmove toward a new goal. Peplau furtherassume that nurse client relationship fostersgrowth in both the client and the nurse.
20. NURSING THEORIES11. Martha Rogers conceptualized the Science of UnitaryHuman Beings. To Rogers unitary man is anenergy field constant interaction with theenvironment. She asserted that humanbeing are more than and different from thesum of their parts. Further more she believedthat human being is characterized by thecapacity for abstraction and imagery,language and thought, sensation andemotion.
21. 12. Sister Callista Roy presented the Adaptation model. She views each person as a unified biopsychosocial system in constant interaction with a changing environment. She contended that the person as an adaptive system, functions as a whole through interdependence of its parts. The system consist input control process, output and feedback. In addition, she advocated that all people have certain needs which they endeavor to meet in order to maintain integrity.
22. These need are divided into four differentmodel, the physiological, self-concept, rolefunction, and interdependence.Accordingly, Roy believed adaptive humanbehaviors is directed toward an attempt tomaintain homeostasis or integrity ofindividual by conserving energy andpromoting survival, growth , reproductionand mastery of the human system.
23. 13. Lydia Hall Introduce the notion that nursing centers around three components of CARE, CORE, CURE. Care represents nurturance and is exclusive to nursing. Core involves the therapeutic use of self and emphasizes the use of reflection. Cure focuses on nursing related to the physician’s orders. Core and cure are shared with other health care providers.
24. 14.Ida Jean Orlando Believe that the nurse helps patients meet a perceived need that the patients cannot meet for themselves. Orlando observed that nurse provide direct assistance to meet an immediate need for help in order to avoid or to alleviate distress or helplessness. She emphasized the importance of validating the need and evaluating care based on observable outcomes. She also indicated that nursing actions can be automatic (those chosen for reasons other than the immediate need for help) or deliberative (those resulting from validating the need for help, exploring the meaning of the need, and validating the effectiveness of the actions taken to meet the need.) Nursing Process Discipline
25. 15. Ernestine Weidenbach The theory of clinical nursing that she is known for has four elements: 1. A nursing philosophy - a nurses attitude and belief about life is what motivates a nurse to act in a certain way. Three important components of a nurses philosophy are reverence for life, respect for the dignity and individuality of each human being, and resolving to act on personal and professional beliefs. 2. A nursing purpose - that which a nurse wants to accomplish through what s/he does. 3. A nursing practice - those (observable) nursing actions that are affected by beliefs and feelings about meeting the patients needs. 4. The art of nursing - this includes understanding a patients needs and concerns, developing goals and actions intended to enhance patients well-being, and directing the activities related to the medical plan to improve the patients condition.
26. 16. Jean Watson Conceptualized the Human Caring Model. She emphasized that nursing is the application of the art and human science through transpersonal caring transactions to help persons achieve mind- body soul harmony, which generates self- knowledge, self-control, self-care, and self-healing. She included health promotion and treatment of illness in nursing.
27. 17. Rosemarie Rizzo Parse Introduce the theory of Human Becoming. She emphasized free choice of personal meaning in relating value priorities, co-creating of rhythmical patterns, in exchange with the environment and contranscending in many dimensions as possibilities unfold. She also believed that each choice opens certain opportunities while closing others. Thus, she referred to revealing-concealing, enabling- limiting, and connecting-separating. Since each individual makes his or her own personal choices, the role of the nurse is that of guide, not decision maker.
28. 18. Josephine Paterson and Loretta Zderad Provided a Humanistic Nursing Practice Theory. This is based on their belief that nursing is an existential experience. Nursing is viewed as a lived dialogue that involves the coming together of the nurse and the person to be nursed. The essential characteristics of nursing is nurturance. Humanistic care cannot take place without the authentic commitment of the nurse being with and doing with the client. Humanistic nursing also presupposes responsible choices.
29. 19. Helen Erickson, Evelyn Tomlin and Mary Ann Swain Developed the Modeling and Role - Modeling Theory. The focus of this theory is on the person. The nurse model (assesses), role models (plans), and intervenes in this interpersonal and interactive theory. They asserted that each individual is unique has some self-care knowledge, needs simultaneous to be attached to and separate from others, and has adaptive potential, nurses in this theory, facilitate, nurture and accept the person unconditionally. They view nursing as a self-care model based on the clients perception of the world and adaptations to stressors.
30. 20. Margaret Newman Focused on health as expanding consciousness. She believed that human are unitary beings 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 time, space, and movement and is ever- expanding. Change occurs through transformation. Nursing is involved with human beings who have reached choice points and found that their old ways are no longer effective. Caring is a moral imperative for nursing. The nurse is a partner with the client rather than the goal setter and outcome predictor.
31. 21. Anne Boykin and Savina Schoenhofer Presented the grand theory of Nursing as Caring. They believed that all persons are caring, and nursing is a response to a unique social call. The focus of nursing is on nurturing persons living and growing in caring in a manner that is specific to each nurse-nursed relationship or nursing situation. Each nursing situation is original. They support that caring is a moral imperative. Nursing as Caring is or based on need or deficit but is an egalitarian model of helping.
32. MORAL THEORIES1. Freud Believed that the mechanism for right and wrongwithin the individual is the superego, or conscience. Hehypothesized that a child internalizes and adopts themoral standards and character or character trait of themodel parent through the process on identification.The strength of the superego depends on the intensityof the child’s feelings of aggression or attachmenttoward the model parent rather than on the actualstandards of the parent.
33. 2. Erickson Erickson’s theory on the development of virtues or unifying strengths of the “good man” suggests that moral development continues throughout life. He believed that if the conflicts of each psychosocial developmental stage are favorably resolved then an “ego- strength” or virtue emerges.
34. 3. Kohlberg Suggested 3 levels of moral development that encompasses 6 stages. He focused on the reasons for the making of a decision, not on the morality of the decision itself. At first level called the pre-moral or pre-conventional level, children are responsive to cultural rules and labels of good and bad, right and wrong. However, children interpret these in terms of the physical consequences of their actions, e.i. punishment or reward. At the second level, the conventional level, the individual is concerned about maintaining the expectation of the family, groups, or nation and sees this as right. Level three is called the post conventional, autonomous, or principled level. At this level, people make an effort to define valid values and principles without regard to outside authority or to the expectations of others. This involves respect for other humans and belief that relationships are based on mutual trust.
35. 4. Peters Proposed a concept of rational moralitybased on principles. Moral development is usuallyconsidered to involve three separate components:moral emotion (what one feels), moral judgment(how one reasons), and moral behavior (how oneacts). In addition, Peters believed that thedevelopment of character traits or virtues is anessential aspect of moral development. And thatvirtues or character traits can be learned from othersand encourage by the example of others. AlsoPeters believed that some virtues can be describedas habits because they are in some sense automaticand therefore are performed habitually, such aspoliteness, chastity, tidiness, thrift, and honestly.
36. 5. Schulman and Mekler Believed that morality is measure of howpeople treat fellow humans and that a moral child isone who strives to be kind and just. They believedthat morality has two components, namely:1. The intention of the person acting must be good in the sense that the goal of the act is the well being of one or more people.2. The person acting must be fair or just in the sense that the person considers the rights of others without prejudice or favoritism. Furthermore, the aforementioned authors asserted that the theory of moral development is based on three foundations, which they believed can be taught, as follows:
37. a. Internalizing parentalstandards of right and wrong.b. developing emphaticreactionsc. acquiring personalstandards
38. 6. Gilligan Include the concepts of caring andresponsibility. She described three stages in theprocess of developing an “ethic of care” whichare as follows:1. Caring for oneself2. Caring for others3. Caring for self and othersShe believed that women see morality in theintegrity of relationships and caring. Fro women,what is right is taking responsibility for others as aself-chosen decision. On the other hand, menconsider what is right to be what is just.
39. C. Spiritual Theories1. FOWLER Described the development of faith.He believed that faith, or the spiritualdimensions is a force that gives meaning toa person’s life. He used the term “faith” asform of knowing, a way of being in relationto “an ultimate environment”. To Fowler,faith is a relational phenomenon: it is “anactive made of being in relation to anotheror others in which we invest commitment,belief, love, risk and hope.”
40. 2. Westerhoff Proposed that faith is a way of behaving.He developed a four stage theory of faithdevelopment based largely on his lifeexperiences and the interpretation of thoseexperiences. These stages are as follows:a) Experience faith (infancy/early adolescence): experiences faith through interaction with others who are living a particular faith.b) Affiliative faith (late adolescence) actively participates in activities that characterize a particular faith tradition.c) Searching faith (young adulthood) through a process of questioning and doubting own faith, acquires a cognitive as well as affective faith.
41. d) Owned faith (middleadulthood/ old age) puts faithinto personal and socialaction and is willing to standup for what the individualbelieves even against thenurturing community.