Nursing Theories with applications

Nursing Theories

• Often considered the first nurse theorist • Defined nursing as “the act of utilizing the environment of the patient to assist him in his recovery”. • Nightingale’s theory remains an integral part of nursing and healthcare today.

• 5 Factors for Environment:

a

Healtthy

– Pure or fresh air – Pure water – Efficient drainage – Cleanliness especially – Light, sunlight

direct

1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING THEORY

Nightingale’s general concepts of Environmental Sanitation includes: 

Proper Ventilation Adequate Lighting Cleanliness Adequate Warmth Quiet Diet


Application: A. Nurs Nursing ing Practice Practice The principles of Nursing Practice by FN are continuously used to this very day. With the advent of technology and with it globalization, comes threats from the environment. > Global Warming > Industrial Noise > Air Pollution > Fad Diets > Vanity Nurses of today still needs to:  Maintain Adequate Ventilation  Promote Adequate & Appropriate Nutrition  Maintain Normal Homeostatic Body Temperature  Observe Basic Hygiene


B. Nursing Education St. Thomas & King’s College Hospital in London - able to provide framework for the establishment of Nursing Training Training Schools through a Universal template that contains principles of nursing training. training. It included instruction in Scientific Principles & Practical Experience for the mastery of skills - FN advocated the separation of nursing training from from hospital hospital to more appropriate appropriate learning environment in the School or University setting. This was advocated for FN believed the SN’s role is to learn the Art & Science of Nursing before being employed in the Nursing Service. - FN is also a strong proponent of practice

Assisting sick or healthy individual individuals s to gain independence in meeting 14 fundamental needs • Patient-centered

2) VIRGINIA HENDERSON: FOURTEEN FUNDAMENTAL NEEDS • Virginia Henderson’s 14 Fundamental Needs of a Person 1) Breathing normally 2) Eating and drinking adequately 3) Eliminating body waste 4) Moving and maintaining a desirable position 5) Sleeping and resting 6) Selecting suitable clothes 7) Maintaining body temperature within normal range by adjusting clothing and modifying the environment

2) VIRGINIA HENDERSON: FOURTEEN FUNDAMENTAL NEEDS 8) Keeping the body clean and well groomed to protect the integument 9) Avoiding dangers in the environment and avoiding injuring others 10) Communicating with others in expressing emotions, needs, fears, or opinions 11) Worshipping according to one’s faith 12) Working in a such way that one feels a sense of accomplishment 13) Playing or participating in various forms of recreation 14) Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health

2) VIRGINIA HENDERSON: FOURTEEN FUNDAMENTAL NEEDS Application:

- pt.’s

ability to perform the 14 basic needs should be assessed before considering the kind of nursing care function you will will administer. administer. Essential to determine determine if if the N will be performing as a HELPER, DOER or a PARTNER Nsg interventions are implemented according to the 14 basic human needs of the patient. The degree of performance, involvement of the pt. and the level of nursing activity will be dependent on the specific role the nurse will be playing

• Focus is on PROPER IDENTIFICATION of the problem • Particularly about the proper NURSING DIAGNOSIS • Nurse-centered

3) FAYE ABDELLA: PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS

21 Nursing Problems 1.To maintain good hygiene. 2.To promote optimal activity: exercise, rest, and sleep. 3.To promote safety. 4.To maintain good body mechanics. 5.To facilitate the maintenance of supply of oxygen. 6.To facilitate maintenance of nutrition. 7.To facilitate maintenance of elimination.


8.To facilitate the maintenance of fluid and electrolytes balance. 9.To recognize the physiologic response 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 illness 14. To facilitate the maintenance of effective verbal and non-verbal communication. 15. To promote the development of productive interpersonal relationshi r elationship. p. 16. To facilitate progress toward achievement of personal spiritual goals. 17. To create and maintain a therapeutic environment. environment.


18. To facilitate awareness of self as an individual with varying needs. 19. To accept the optimum possible goals. 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.


Application: • Bedside Nursing The N’s ability to address & effectively manage the 21 Nursing problems will spell the patient’s state of health – whether he fully recovers well & fast, or deteriorate further with devastating consequences Ns therefore, have very important role to play. By adhering to these nursing problems, the

• Nursing is a HUMANISTIC and SCIENTIFIC mode of helping through CULTURE-SPECIFIC PROCESS

• Emphasizes human caring varies among cultures • Culture Care Preservation and Maintenance • Culture Care Accommodation and Negotiation • Culture Care Restructuring and Repatterning

4) MADELEINE LEININGER: TRANSCULTURAL NURSING THEORY Application: Important esp because of the rapid expansion of knowledge & increasing globalization with the advent of advances in ICT. Working Overseas Impt to learn the cultures of other people because each culture has its own sets of patterns, expressions & values of caring. Getting acquainted with the culture of a country you are seeking employment as a professional nurse will be a good stepping stone towards towards a more fulfilling career in nursing.

5) Views the person as a irreducible whole, the whole being greater than the sum of its parts – Man is composed of energy of energy fields, fields, which are in constant interaction with the environment – Seek to promote harmonic interactions between the two energy fields (Human and Environmental)

5) MARTHA ROGERS SCIENCE of UNITARY HUMAN BEING

Application Her theory is relevant in today’s nurses focusing on the Totality of the Person. Nurses should strive to promote symphonic interaction between the 2 energy fields in order to strengthen the coherence & integrity of the person.

6) Patient has THREE (3) interacting systems – Individuals / Personal systems How the nurse views and integrates self based from personal goals and beliefs.

– Group systems / Interpersonal systems How the N interrelates w/ a co-workers or pt. particularly in N-Pt. relationship

– Social systems how the N interacts w/ co-workers, superiors, subordinates & the ct. environment in general

6) IMOGENE KING GOAL ATTAINMENT THEORY Action A means of behavior or activities that t hat are towards the accomplishment of certain act. It is both PHYSICAL & MENTAL. Mental (POA) Action (Goal Setting w/ Ct.) Perform

Achieve Goal

Reaction A form of reacting or response to a certain Stimuli.

Interaction Any situation wherein the N relates r elates & deals With a ct. or pt.

6) IMOGENE KING GOAL ATTAINMENT THEORY

Application: Provides enough direction to how nurses should be able to behave or act in in the presence of pts. Since majority of nursing activities involves direct interaction w/ pts., Ns should understand the basic implications of the Action-Reaction-InteractionAction-Reaction-InteractionTransaction model of the N-Pt. Relationship.

Peplau is a psychiatric nurse – Focus: Therapeutic process – Attained through: Healthy Nurse-Patient Relationship

7) HILDEGARD PEPLAU INTERPERSONAL RELATIONS MODEL

• Four (4) Phases Patient Interaction

of

Nurse-

1. Orientation • Nurse and patient test the role each one assumes patient for • Prepares termination • Patient identifies areas of difficulty


2. Identification Phase • Patient identifies with the personnel who can satisfy his needs

3. Exploitation Phase • Nurse maximizes all the resources to benefit the patient


4. Resolution Phase or Termination Phase • Occurs when patient’s needs have been met


Application Significant in terms of the different phases of the N-Pt. interaction & the different ROLES the N can play in giving nursing care to pts. It thus becomes important for nurses to understand the principles behind each of these concepts so that clinical nsg will be more meaningful for the nurse. Eventually, this will translate to pt. outcomes like: Improved health Prevention of Disease pr Enhancement of care faculties

• Nursing involves the application of ART and HUMAN SCIENCE through TRANSPERSONAL TRANSACTIONS in order to help the person achieve mind, body and soul harmony

7 Assumptions on the Science of Caring 1.

Cari Caring ng can can be be effe effect ctiv ivel ely y demo demons nstr trat ated ed & practiced only interpersonally

2.

Effe Effect ctiv ive e car carin ing g pro promo mote tes s hea healt lth h and and individual or family growth

3.

Cari Caring ng resp respon onse ses s acc accep eptt a pers person on not not only as he or she is now but as what he or she may become

4.

A car carin ing g env envi. i. Is one one tha thatt off offer ers s the the dev’t of potential while allowing the person to choose the best action for himself at a given point in time.

5. Caring is more “healthogenic” “healthogenic” than is curing. The practice of caring integrates biophysical knowledge w/ knowledge of human behavior to generate or promote hx & to provide care to those who are ill. A science of caring is therefore complementary to the science of curing 6. The practice of caring is central to nursing

10 CARATIVE FACTORS 1.

Form Format atio ion n of a Huma Humani nist stic ic-A -Alt ltru ruis isti tic c syst system em of values

2.

Instilla llation ion of of fa faith-Ho -Hope

3.

Cult Cultiv ivat atio ion n of of sen sensi siti tivi vity ty to one’ one’s s self self & to to others

4.

Deve Develo lopm pmen entt of of a hel helpi ping ng-t -tru rust stin ing, g, huma human n caring relationship

5.

Pro Promotio otion n and acce accep ptan tance of the the expression of positive & negative feelings;

6.

Syst System emat atic ic use use of a crea creati tive ve prob proble lemmsolving caring process

10 CARATIVE FACTORS 7. Promotion of transpersonal teaching-learning 8.

Provision for a supportive, protective and corrective mental, physical, societal & spiritual environment

9.

Assis Assista tanc nce e with with grat gratif ific icat atio ion n of huma human n need needs s

10. Allowa Allowance nce for existent existential ial-ph -pheno enome menol nologi ogical cal-spiritual forces

Application: Her model of nursing reflects & embodies the TRUE ESSENCE or nursing profession to this very day. It viewed the pt. as the Mind-Body-Spirit entity that needs holistic nursing care. It thus becomes a must for all nurses to view each pt. in the light of the caring theory of Watson. One major implication of the theory is in the realm of Bedside Nursing, where Ns of today have particularly begun to neglect. The essence essence of nursing is in the caring aspect & caring is taking the wholeness, the totality of the pt. into consideration. It is every Ns duty & obligation to care for his pt. not by merely looking into and caring for his physical dse.but try to care for the pt. for who he is.

The Nursing Process is an interaction of Three Basic Elements: 1. Patient’s Behavior 2. Nurse’s reaction 3. Nursing Actions – designed for the patient’s benefit The Role of the Nurse is to find out & meet the Pt’s stat need for help. Ns should use his perception, thoughts about the perception or the feeling engendered from their thoughts to explore with patients the meaning of their behavior

The use of the theory keeps the N’s focus on the patient Application: The Theory increases the Therapeutic Effectiveness of nurses by the expression of Empathy, Warmth & Genuineness esp in the light of addressing the Stat Need of the Patient for help. This framework will be important for Ns who are assigned in special clinical areas that requires quick decision making & critical thinking skills. If the patient’s condition improved, then the intervention is effective

10) JOYCE TRAVELBEE INTERPERSONAL ASPECTS OF NURSING THEORY

Human to Human Relationship 

Greatly emphasized on the Therapeutic Human Relationship between the Nurse & the Patient.



Her model emphasizes: Empathy Sympathy Rapport & the Emotional aspects of Nursing

4 Interlocking Phases that precedes RAPPORT And the establishment of N-Pt. Relationship:  Original Encounter

10) JOYCE TRAVELBEE INTERPERSONAL ASPECTS OF NURSING THEORY Human to Human Relationship Application: The theory describes the various stages of interpersonal elations that occur bet a Patient and a N. It thus becomes important for Ns to fully understand the phases and its effects to the patient’s welfare. Due consideration should be given to the pt’s inherent personal characteristics to interact w/ other people, most especially Ns & other members of the healthcare professions. The key concept of Empthy, of Empthy,

• Focuses on 10 Categories of determinants of healthPromoting Behaviors. • Views a person’s healthpromoting behavior in the light of his individual characteristics & experiences

• The 10 Determinants are: – – – – – – – – – –

Prior related behavior Perceived benefits of action Perceived barriers of action Perceived self-efficacy Activity related effect Interpersonal Influences (family, friends, providers) norms, support & models Situational Influences ( options, demand characteristics, aesthetics) Immediate competing demands (low control) and preferences (high demand) Commitment to a plan of action Personal Factors ( Biological, Psychological, Sociocultural)

Application:

Health Promotion Activities are the major Focus of Hx Care Organizations. In order for Patients to take on the Behaviour we, Hx care professionals, advise them to take, we should carefully looked into a host of factors that can influence his decision to really adopt the behaviour. It is important for Ns to be for the pts.

ROLE MODELS

• The model is based on the Person’s Relationship to Stress, his Reaction to it and Reconstitution factors that are dynamic in nature • The concern of nursing is to PREVENT STRESS INVASION

• Person is viewed as an Open System composed of Basic Structure of Energy Resources which includes: • Physiologic • Psychologic • Sociocultural • Developmental • Spiritual

Basic Structure/Central Core - surrounded by 2 concentric boundaries or Rings called Lines Of Resistance which represents the internal factors that AID the person Defend against a Stressor. Lines of Resistance – further surrounded by 2 lines of Defense 1. Normal Line of Defense

1. Normal Line of Defense - person’s state of equilibrium or the state of adaptation developed & maintained over time and which is considered normal for the person 2. Flexible Line of Defense - dynamic and can be readily and rapidly changed over a short period of time. - adjusts to situations that threatens the imbalance w/in the client’s stability Stressors: Intrapersonal Interpersonal Extrapersonal

FOCUS of Nursing Interventions : - keeping or maintaining the stability of the open system which can be carried out on three levels of prevention APPLICATION Very comprehensive model of nsg that outlines the way how Ns provide HOLISTIC NURSING CARE to pts. Emphasis is on the management of o f Stress thru adequate understanding of the complex client system. Strong Advocate of Prevention Interventions which is congruent to the aims of modern-day nsg & Hxcare services. It is a MUST that Ns perform thorough & comprehensive assessment that includes ALL aspects of the Ct.

• Man is a BIOPSYCHOSOCIAL BEING • Four (4) modes of Adaptation – Physiologic Mode – Self Concept – Role Function – Interdependence

Her Model is best exemplified in the Nursing Process which includes the following steps: 1. Assessment of Behavior 2. Assessment of Stimuli 3. Nursing Diagnosis 4. Goal Setting 5. Intervention 6. Evaluation

APPLICATION Best applied in the performance of the Nursing Process which is cyclical in nature. The Assessment component is the Stimuli or Input The Planning & Implementation are the Throughput process. The Evaluation which provides necessary feedback to the Goal of care is the Output. The N decides what necessary actions should be taken next in the light of the patient’s response to the Nursing Interventions. This action by the N is Adaptation in its simplest terms Patients adopt too. The Nursing interventions we perform ultimately elicits a response from them. Depending on the nature & extent of the nursing interventions, pts may or may not actually adopt according to our expectations

Three (3) Nursing Systems based on Art of Care of Patient Needs • 1. Wholly Compensatory or Total Compensatory – For paralyzed patients, for ICU patients • 2. Partial Compensatory – Patient performs some nursing care needs • 3. Supportive-Educative Supportive-Educative – For up and about patient

of

APPLICATION The elements of the theory clearly emphasize the need to understand the importance of self- care in the Promotion and maintenance of Health & Wellbeing. Focus on the pt’s capacity/ability to perform self-care activities in order to determine which self-care activities to perform for the client.

The model emphasizes on Education & Supportive Measures Health Education – very important aspect of clinical nursing today

Her concern is: “How do Nurses learn to do Nursing” Experience-based

skill acquisition – is safer & quicker when it is founded on a sound educational base Skill

– refers to Nursing interventions and Clinical judgment skills in actual As the N gains experience, Clinical knowledge clinical situations. becomes a GOOD MIX of PRACTICAL &

LEVELS OF SKILL ACQUISITION:

1. Novi Novice ce 2. Advanced Advanced Beginner Beginner 3. Compet Competent ent 4. Profic Proficien ientt 5. Expe Expert rt

APPLICATION

Instrumental in differentiating knowledge development & career progression in Nursing. It is important for Nursing students and professional nurses alike to learn through Experience or by Experiential Learning. Learning by experience will allow you to gain Mastery of a given skill.

Individuals could be conceptualized in 3 Separate Domains:

1. CARE – hands on bodily care 2. CORE – using the self in relationship to the t he client

3. CURE – applying medical knowledge

Nurses function in all 3 Domains but in different Degrees. 1. CURE – limited to helping patients/families deals w/ the measures instituted by the physician 2. CARE – exclusive for nursing

16) LYDIA HALL CORE, CARE, CURE MODEL APPLICATION Foundation for classifying the Professional N’s functions today. Ns are able to carry out Nursing Interventions I nterventions INDEPENDENTLY DEPENDENTLY INTERDEPENDENTLY

CORE – maintains that it is the N responsibility to make sure that the t he client receives the highest level of care possible from all concerned Hx Professionals. Ns ROLES: COLLABORATOR, COORDINATOR and in COOPERATION with other members of the HX team that pertains to

CURE – clearly delineates nursing functions that are DEPENDENT on the members of the Medical Profession. Interventions carried out needs a written order from the doctor/s

CARE – refers to the independent roles & functions of the Nurse insofar as her knowledge & skills about the patient’s p atient’s condition will allow her to carry on with her Nursing Responsibilities

17) MYRA LEVINE: FOUR CONSERVATION PRINCIPLES OF NURSING • 1. Conservation of Energy – Example: complete bed rest without bathroom privileges • 2. Conservation of Structural Integrity – Example: turn patient from side to side every two hours to avoid bed sores

17) MYRA LEVINE: FOUR CONSERVATION PRINCIPLES OF NURSING • 3. Conservation of Personal Integrity – Example: maintain patient’s privacy • 4. Conservation of Social Integrity – Example: maintenance of patient’s relationships

17) MYRA LEVINE: FOUR CONSERVATION PRINCIPLES OF NURSING APPLICATION Ns should be able to identify the many Nurse-Patient activities which are implied in the 4 Conservation Models. It can be be applied applied to to geriatric nursing where majority of the elderly pts will have some problems in at least 2 of the conservation models. Structural integrity focuses on the body’s ability to ward of infections & other bodily harm. It means means that it is important to keep these barriers – skin &

– Focus is on Eleven (11) Health Patterns – Advantage to the nurse: • It enables the nurse to determine the client’s response as functional or dysfunctional

• Eleven Functional Health Patterns – – – –

Health perception Nutritional / Metabolic Elimination Activity and Exercise Pattern – Cognitive Perceptual Pattern

• Eleven Functional Health Patterns – Sleep and Rest – Self perception / Self concept – Role Relationship Pattern – Sexuality / Reproductive – Coping-StressTolerance – Value Belief Patterns

SISTER LETTY G. KUAN Dissertation: “Retirement & Role Discontinuities” Discontinuities” “I

have grown and sown and now I can reap the reward & blessing of a life lived in joy & love, for I too have made CONCEPTUAL MODEL others grow” Determinants of Fruitful Aging 

Prepared retirement Health Status  Income  Family Constellation  Self-preparation 

Retirement Role Discontinuities (Aging Process)

Change of Life

Outcome Fruitful Retirement And Aging

CARMENCITA ABAQUIN Dissertation: “PREPARE ME” Interventions & the Quality of Life of Advance Progressive Cancer Patients “To Nursing… may be able to provide the care that our clients need in maintaining their quality of life and being instrumental in “Birthing” them to External life” CONCEPTUAL FRAMEWORK

Holistic Nursing Intervention

“PREPARE ME” 

Presence

Reminisce

Therapy

Prayer Relaxation Activities Meditation Value Clarification

Terminally ILL Patients (CANCER) Physical Psychological Social Religious Level of Independence Environment Spiritual

QUALITY OF LIFE

Nursing Theories with applications

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